Facility Evaluation Report

On 12/5/22 at 2:40pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual visit. LPA Jensen met with Administrator Amanda Jacobs and explained the purpose of today's visit. Amanda holds current Administrator certificate # 6051897735 which is good through 10/21/23.

LPA Jensen toured the grounds and physical plant. There is a single designated entrance equipped for COVID screening. There is a sign in log at the entrance, a wall thermometer for temperature screening, sanitizer and PPE available.

All required signs were posted in prominent locations in the facility including but not limited to infection control, personal rights, employee rights, see something-say something, facility sketch and emergency disaster plan.

The facility was observed to be sanitary and free of odor. There are 5 single occupancy bedrooms. Each bedroom was furnished with a dresser, night stand, lamp and chair. The facility maintains an adequate supply of linen and bedding. The bathrooms were observed to be equipped with grab bars and non-slip mats in the shower. The water temperature in the bathroom main hall was measured at 111.6 degrees which falls within the required regulatory range of 105-120 degrees. The water heater is equipped with a regulator that does not allow the water to heat above 120 degrees. The thermostat was set at 72 degrees for the comfort of the residents. LPA Jensen observed emergency lighting to be available in the facility and the hallways were equipped with night lights leading to the bathroom. All toxins and cleaning supplies were observed to be locked and inaccessible to residents in care.

The fire extinguisher was last serviced in March of 2023 and is in compliance. The carbon monoxide detector was tested and observed to be in good working order.