Facility Evaluation Report

At 9:00am on 04/15/2024, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct an annual facility inspection. LPA met with Lead Staff Rob Derrick, announced who he is and the reason for the visit.

Lead Staff and LPA conducted a full tour of the facility. This facility is one of two located on the same 30-acre property in a rural area. The facility is a 4-bedroom, 2-bathroom modular home with a living room, kitchen and dining nook. Of the 4 bedrooms, two are single client bedrooms and two are live-in staff bedrooms, clients share one full bathroom, the other bathroom is attached to the primary staff bedroom. LPA noted fresh fruit and snacks in the kitchen readily available for clients to enjoy freely. LPA noted that the front yard has seating and shade for clients. LPA observed a fire extinguisher near the kitchen that was in the green compression range. LPA tested facility hot water at 112.8*(f) and was within regulation temperatures 105*-120* (f). LPA noted the current clients have resided at this facility for 24-35 years. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. There are permanently installed Tesla battery backup units to provide facility power during an extended outage. LPA noted the facility has no obstructions in hallways, doorways or exits. Medications are locked in a cabinet in the kitchen area. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review. During staff file review and review of the Administrator Certification Bureau 's active, pending, and initial administrator lists updated as of 04/11/2025, LPA noted facility does not have a currently certified administrator.

LPA and Lead Staff conducted a review of the annual care tool modules.

Exit interview, report signed, citation and appeal rights given, and report provided.