Facility Evaluation Report

On 11/20/2025 at 9:30, licensing program analyst, LPA, Noel Wolf Petersen arrived to conduct an annual inspection. LPA met with staff Monica and later Administrator Micheal Cooks and House manager Nichole Cooks, to explain the purpose of the visit. current census of 4, no restricted or prohibited conditions.

Physical inspection included but was not limited to the bedrooms, bathrooms, storage area, exteriors, common areas, kitchen, and evacuation route. Facility is clean, traffic areas are well lit and unobstructed.

2 random clients medications and mars were checked, facility uses Alchemy electronic records they seem to have required fields. fire extinguisher was dated 4-16-2025. smoke alarm is functional. Water measured 117*F.

Client Records- 4 of 4 client records were inspected including but not limited to: signed admission agreements, medical consents, house rules, grievience policy, recent medical assessment, IPPs, and needs and services plans. Records are present and up to date.

Staff Records- 5 of 9 staff records were inspected including but not limited to their fingerprining clearance, backround check, tb test, first aid/cpr, initial and continuing training records. Records are present and up to date

Administrator records- an inspection of records included but was not limited to: the required posters, the certification, the license, facility sketch, infection control plan, evacuation plan, control of property, liability insurance, and surety bond. records are present and up to date.

Client interviews- 2 residents are at program, 2 residents have a pretty severe cough. Both residents report liking the conditions of the residence, they are clean and well fed in appearance.

Staff interviews- 2 staff were interviewed, they are aware of the client rights and reporting requirements.

No Citations issued at this time, a copy of the report was read and given to the administrator, exit interview conducted.