Facility Evaluation Report

On 4/7/22 Licensing Program Analyst (LPA) Maja Jensen arrived unannounced to conduct a required one year annual inspection. LPA met with Administrator Leah Zubiate and explained the purpose of today’s visit. The facility has a central entry point with COVID screening logs, a sign in sheet, surgical mask and sanitizer. LPA was allowed entry into the facility and was accompanied by the Administrator during the facility tour.

The physical plant was toured inside and outside including but not limited to resident bedrooms, bathrooms, kitchen, laundry room, dining room, living room and backyard. LPA observed the facility to be clean. Lighting throughout the facility was observed to be adequate. The furniture observed was in good repair. The outdoor space had been freshly mowed and was clear of debris. The thermostat in the facility was set at 70 degrees which falls within the required range of 68-85 degrees. The water temperature in the bathroom was 114.8 which falls within the required range of 105 to 120 degrees. The laundry room was observed to have detergent and toxins locked and inaccessible to residents. Cleaning supplies were locked and inaccessible to residents. The medication cart was observed to be locked and inaccessible to residents. The kitchen was observed to be clean and sanitary. Appropriate signage was observed to be posted in a prominent location including "See Something, Say Something", personal rights, employee rights, emergency disaster plan and facility sketch. The facility sketch accurately depicted the layout and usage of the rooms within the facility. An activity schedule was observed to be posted and a weekly meal menu was posted. The activity room was observed to be clear of debris. LPA interacted with various residents during the course of the visit.

The first aid kit was observed and found to be in compliance. The fire alarm and carbon monoxide detector were tested and found to be in good repair. The fire extinguishers were last serviced in July of 2021 and are in compliance. A 30 day supply of PPE was observed on site.

No deficiencies were cited as a result of today's visit. An exit interview was conducted and a copy of this report was left with the facility.