Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 12/29/2022 at 2:47pm. LPA met with facility Administrator Marilou Williams(Admin).

LPA toured the facility, including living room/dining room, kitchen, laundry room, 1 staff bedroom, 3 resident bedrooms, 2 bathrooms, back yard, and garage. No staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated.

Facility observed to have designated entry point. LPA's temperature was checked and symptoms were screened. 30 day supply of PPE observed. Restrooms were stocked with paper towels. Hand washing signs observed to be in all bathrooms. Social distancing signs observed to be posted in all public areas. The facility is currently accepting visitors inside the facility, including residents' bedrooms.

Facility infectious 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. Fire extinguishers observed to have been purchased in July of 2022. Facility carbon monoxide detector tested and observed to be in working order. Facility water temperature observed to be at 111.9 *F.

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