Facility Evaluation Report

Licensing Program Analyst (LPA) Erika Miller arrived at 8:30 a.m. to conduct a 1-year required annual visit. LPA met with Sheryll Ann Saniatan, Back-Up Administrator. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Infection Control: The facility has a current Infection Control Plan. The facility has at least a 30-day supply of PPE. 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).

Physical Plant & Environment Safety: LPA was authorized to enter and inspect facility. LPA toured 10 resident rooms and observed that rooms were tidy . The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have slip-resistant mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and locked in laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. The fire extinguisher was last charged and inspected on September 16, 2024. The facility has smoke and carbon monoxide detectors that were tested and/or inspected.

Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance. The facility is approved for a capacity of 32. The fire clearance is granted 20 non-ambulatory residents, of which 7 may be bedridden and 5 ambulatory residents. A hospice waiver is approved for 6 residents. The facility currently has 18 non-ambulatory residents and 3 ambulatory residents. There are currently 4 residents on hospice care. Continued on 909-C