Facility Evaluation Report

At 07:50am, on 05/28/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Lead Staff Hunter Young, announced who he was and the reason for the visit.

Lead Staff and LPA conducted a full tour of the facility. This facility has two dual occupancy client bedrooms, two staff bedrooms, and two full bathrooms (one is on-suite to the primary staff bedroom and one is for shared/public use). There is a living room with dining space and a kitchen. Access to the laundry area and garage is through a locked door for client safety. The garage is also used for client activities while staff are present. LPA noted that the backyard and the front yard both have seating and shade for clients to enjoy. LPA noted fresh fruit and snacks in the kitchen for clients to enjoy freely. The facility has wired combo carbon monoxide/smoke detectors in each room and hallway leading to bedrooms that are all working. LPA observed 3 fire extinguishers throughout the facility tagged current and in the green compression range, serviced on 12/03/2024. LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. Staff and client files, and medications are locked in a cabinet in the garage. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review.

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

Exit interview, report signed, and report provided.