Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Kaitlyn Brownell. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. 4 residents and 4 staff were observed in the facility. LPA reviewed 2 resident file and 2 staff files. One staff was observed at the facility who was associated with the facility but was disassociated with the facility 4/5/2024. ADM stated there might be some mistake.

Family room, living room, kitchen, dining area, 2 restrooms, and garage were inspected. 3 shared resident bedrooms were inspected. one staff room was observed in the facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and chemical closet were observed locked. Room temperature was at 75 degree F, and hot water temperature was at 110 degree F in facility. THe temperature of the freezer was observed at 0 degree F, and the temperature of the refrigerator was observed at 40 degree Fire extinguisher was serviced on 6/5/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility.

Front yard and backyard were inspected. There was no obstruction to block the walkways. A storage room was observed at backyard. The last time the facility conducted the emergency and fire drill was on 4/12/2025.

Deficiency noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.