Facility Evaluation Report

Licensing Program Analyst (LPA) Melisa Rankin arrived at 8:50 a.m. to conduct a 1-year required annual visit. LPA met with Johanna N. Membrebe, Administrator.

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

Physical Plant & Environment Safety: LPA toured resident rooms and observed that rooms were sufficiently tidy. The lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational. The showers have non-skid flooring. The indoor pathways are clear of any obstructions. 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 residents’ use. The fire extinguisher is charged. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit.

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 is approved for a capacity of 6 ambulatory and has current census of 5 ambulatory residents.

Staffing and Training Records: The facility currently employs 1 full-time staff, 2 back-up staff, and 1 administrator. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator Certificate expires on 11/15/26. The facility keeps confidential files for each staff member. Training for 2025 was reviewed and discussed for updates. Continued 809-C