Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:00 am to conducted a 1 year annual visit to the facility above. LPA met Administrator Todd Tose and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit:

Infection Control: The facility has submitted a current Mitigation Plan, Infection Control Plan, Emergency Disaster Plan and provide plans to the department. The facility has a sign in and out binder for visitors at entry with hand sanitizer and symptom screening. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has trash bins with covers. The facility has a 30 day supply of PPE. New residents are tested and negative results received before residing in the facility. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers.

Physical Plant & Environment Safety: The facility is a 23 bedroom and 23 bathroom currently occupying 21 residents and employs 20 staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has a carbon monoxide detector, smoke alarm and sprinkler system. The lighting and lamps are sufficient for the use of the facility and for residents comfort. The facility kitchen has a tap with hot water and warning sign is posted. The showers have non-skid textured floors. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The facility has a signal system in each residents room. The pathways are clear of any obstructions, well lite and equipped with hand railings where needed on ramps and porches. Fire places has screened coverings. Disinfectant, cleaning solutions and poisons are inaccessible to clients in care. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for resident use.

Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 02/02/2024. The facility is approved for a capacity of 32 Non-Ambulatory and has a current Hospice wavier granted for 6.