Facility Evaluation Report

On 03/15/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA Pascua met with Facility Designated Representative (FDR), Mary Baldwin and explained the purpose of the visit. This facility is licensed to served and accept up to 6 residents who are deemed to be ambulatory only. This facility is also vendorized to accept and retain Level 4I residents at this time.

LPA reviewed 3 resident files. 3 out 3 resident files are complete and up to date. LPA reviewed 4 staff files. 4 out 4 staff files are complete and up to date.

Fire extinguisher located by the kitchen and upstairs closet appeared to have been annually inspected on 06/15/2023.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

Kitchen area was toured. Food storage units were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Additional non-perishable food supply was identified in the pantry and garage.

LPA Pascua observed a locked centralized stored medication closet located in the dining room. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the garage was conducted. Additional storage for supplies were stored in cabinets.

A tour of the laundry room was conducted. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees.

A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of the staff bedroom was also conducted.

A linen closet was located in the office and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.`