Facility Evaluation Report

On 3-22-24, Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to conduct a case management visit regarding incidents which occurred on 2-24-24. LPA met with staff and explained the purpose of the visit. LPA reviewed incident reports dated 2-24-24 and facility file documentation for resident 1 (R1). LPA also conducted health and safety facility tour as part of this case management. Additionally, LPA interviewed staff.

On 2-24-24, facility reported that, R1 was not found to not be responsive during round. Facility provided for LPA Lewis R1'S IPP, 602 (physician report) and annual review of R1. LPA conducted facility tour with staff. LPA observed facility common areas, various resident rooms, kitchen area and hallways. Facility was observed by LPA to be clean and sanitary. Floors and walls were clean without prominent stains. Facility was observed to contain no foul odors. Food supply was adequate with 7 days of non-perishables and 2 days of perishable items in place. Staffing levels included, 3 caregivers. Room temperature was 71*F. Smoke alarms and carbon detectors are functioning properly. Current census is 4. No obstructions to fire exits noted during today's tour. As a result of today's case management visit, no deficiencies are being cited under Title 22, Division 6, Chapter 8. Facility will email LPA a copy of the DNR for R1.

An exit interview was conducted with staff and a copy of this report was given.