Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted a unannounced annual inspection visit and met with staff Myrna Brownell (S1).

LPA observed license and personal rights posters in the facility. LPA did not see Administer Certificate in the facility. Administrator (ADM) Kaitlyn Brownell stated on the phone that he/she renewed it and sent the document already. S1 showed a copy of the check that ADM paid for renewal fee of ADM Certificate. ADM stated he/she will provide all the necessary documents later.

LPAs checked 2 resident files and 2 staff files. Resident R1's appraisal/needs and service plan was completed on year 2020 and resident R2's appraisal/needs and service plan was completed on year 2021. LPA did not see resident R2's Admission Agreement. ADM stated on the phone that he/she will send to LPA via email. LPA observed 4 staff and 4 residents in the facility.

LPA toured the facility inside out with S1. LPA toured living room, family room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked.

There are 3 resident bedrooms, 1 staff live-in room and 2 restrooms in the facility. One of the three resident rooms was observed without screen window. No non skid mat was observed in the bathrooms. S1 installed non skid mats in both bathrooms before LPA finished the inspection. Room temperature was observed at 74 degree F, and hot water temperature was observed at 110 degree F. The temperature of refrigerator was observed at 40 degree F, and the temperature of the freezer was observed at 0 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. First aid box, and flash lights were observed in the facility. No night light was observed in the facility. S1 installed night lights before LPA finished inspection. The last time the facility conducted the emergency drill is 6/17/2024.