Facility Evaluation Report

On 7/7/2025, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with and explained the purpose of the visit.

The facility physical plant was inspected the including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Advisories given for three bags of spoiled Kale (leave were yellow and liquid was forming in the bags), ECO lab reports missing and cloth towels in all residents bathrooms and the paper towel dispensers were not working in 8 of 8 rooms inspected. Hot water temperature was measured at 107.0 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety.

LPA observed centrally stored medications locked in each section of the facility. LPA reviewed and compared resident medication vs. resident medication logs. LPA attempted to reviewed 10 resident and 5 staff files, including criminal record clearances. Advisories given for incomplete information on staff applications (I-9 form blank and criminal record statements missing explanation for marking yes on the question). Fire drill was completed on 5/28/2025. First aid kit was checked and is complete. No deficiencies were cited. Advisories given. Exit interview conducted