Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 12/29/2022 at 12:58pm. LPA met with facility Administrator Betty Jean Jaurique (Admin).

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

Facility observed to have designated entry point with sign in process. No signs were posted at the front of the facility. Admin took LPA's temperature but did not screen for symptoms. 30 day supply of PPE observed. Restrooms were stocked with paper towels for hand washing. Hand washing signs were not observed to be posted in all public bathrooms. Social distancing signs not posted in 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 adequately 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. Facility carbon monoxide detector observed. Facility water temperature observed to be at 136.9 *F.

Deficiency cited during today's visit. Advisory notes issued. This report was reviewed with Administrator Betty Jean Jaurique (Admin) and a copy of the signed report was provided.