Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 9:11 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Shirley Oani, administrator and explained the purpose of the visit.

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: The facility has 5 bedrooms and 3 bathrooms facility, 4 bedrooms are resident rooms and 1 bedroom is staff. currently occupying 5 residents. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid flooring. 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. There is sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with some shade. The fire extinguisher was inspected on 8/7/25.

Operational Requirements: The facility has current liability insurance that expires on 1/9/27. The facility is approved for a capacity of 6. The fire clearance is granted for 4 non-ambulatory residents and 2 ambulatory. A hospice waiver is approved for 3 residents.

Personnel Records & Training: The facility currently employs 4 full-time caregivers, 2 of which are administrators and back-up caregivers are available. Staff records are kept confidential. Files reviewed for, but not limited to current 1st Aid/CPR, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions all files complete. Administrator’s Certificates expires 5/9/26. Staff have annual training completed for various subjects/topics and hours for 2025. Continued 809-C