Facility Evaluation Report

At 9:10am, on 12/5/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee Donna Derrick, announced who he was and the reason for the visit. The facility is located in a rural location. There are local emergency services in this area. The clients in this home have been at this location between 39 to 56 years.

Licensee and LPA conducted a full tour of the facility. This facility has three dual occupancy client bedrooms, one full shared bathroom, a live-in staff bedroom with attached full bathroom. There is a living room, dining room, family room with additional dining space, a kitchen and laundry room. Access to chemicals in the laundry room is through a locked cabinet. LPA noted that the front patio has seating and shade for clients. LPA noted fresh fruit and snacks in the kitchen for clients to enjoy freely. The facility has battery operated dual smoke and carbon monoxide detectors in each room that are all working. LPA observed multiple fire extinguishers throughout the facility in the green compression range, purchased in February and April of 2025. LPA tested facility hot water within regulation temperatures 105*-120* (f). LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA noted the facility to have no obstructions in hallways, doorways or exits. Medications are locked in a lock box. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review.

LPA and Licensee conducted a review of the annual care tool modules. There were no deficiencies cited at this time.

Exit interview conducted, report signed, and report provided to the Licensee.