Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Derek Koen . During the visit, LPA observed 6 residents and 3 staff. LPA explained the purpose of the visit.

As LPA entered the facility, LPA observed 3 staff. LPA asked the staff's name and cross referenced their names with the LIC536, Facility Personnel Report Summary. LPA observed that staff S1 and S2 were not associated with the facility. LPA searched Staff S1 and S2 in guardian, and both staff are fingerprint cleared, but not associated with the facility.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways.

While touring the upstairs of the facility, LPA observed a shelf directly in front of the stairs. LPA observed a cloth covering the sheet. Behind the sheet was 2 detergent containers and a can of paint. (Photograph was taken.) ADM removed the chemicals and stored them in the staff room, inaccessible to residents in care.

While touring the garage, LPA observed part of the garage was sectioned off with a wall. LPA observed inside this sectioned off part of the garage, a couch, television, cloths, and blankets. (Photographs were taken.) ADM stated he will sometimes sleep in the garage. ADM stated he doesn't know if staff, when on break, will sleep in the garage. Based on a review of the facility sketch, the garage is listed as a garage, which is listed as "off limits." LPA interviewed staff S1 and S2. Both staff interviewed stated staff S4 has been sleeping in the garage for the past month.