Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 05/10/2023. LPA met with facility administrator Rebecca Barcellano (Admin).

LPA toured the facility, including living room, kitchen, dining room, 3 resident bedrooms, 1 staff bedroom, 2 bathrooms, garage, and back yard. Admin confirmed that all staff and residents have been vaccinated. Facility Infection Control plan has already been submitted. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained.

Hand sanitizers, soap, and paper supplies were observed to be available. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. Smoke/carbon monoxide detectors were tested and observed to be fully operational. Facility temperature observed to be 72 *F. Water temperature observed to be 113.0 *F.

LPA inspected resident and staff files. 5 out of 5 resident files reviewed were observed to be complete, 4 out of 4 staff files reviewed were observed to be complete. LPA performed an audit of facility medication cabinet. 4 out of 4 resident medication trays noted to have all prescribed medication. Medication administration records observed to be up to date and medication lists observed to contain all necessary corresponding information as observed on medication labels. LPA was unable to interview facility residents due to their nonverbal status. Facility file observed to have all necessary information and documents.

No deficiencies cited during today's visit. This report was reviewed with facility Administrator Rebecca Barcellano and a copy of the signed report was provided.