Facility Evaluation Report

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

This facility is a single story building licensed to serve four (4) 2 non-ambulatory residents and 2 ambulatory residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (111) degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced . Thermostat observed at (70) degrees Fahrenheit.

LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed resident and staff files, including criminal record clearances. LPA reviewed fingerprint clearance and associations to the facility. First aid kit was checked and is complete.

The following forms need updating and were received by CCLD on 2/27/2026:

LIC 308, LIC 500, LIC 610, LIC 9020, Liability insurance certificate, Administrator Certificate.

There were no deficiencies found at this time. Exit interview held