Facility Evaluation Report

On December 20, 2024, at 12:10 PM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Administrator, Shelly Goss and disclosed the purpose of the inspection. The administrator informed the LPA that the facility currently has (2) staff members present and (5) residents in care, (4) residents are ambulatory and (1) resident is on wheelchair. Residents were observed coming back from their day programs during LPA's presence at the facility.

At 12:18 PM, the LPA initiated a walk-through of the facility, accompanied by the administrator.

LPA inspected the kitchen and found it clean, with no food preparation or cooking in progress at the time. LPA checked the appliances and observed them in working order. The locked cabinet containing knives and the locked cabinet under the sink with soap and cleaning supplies were also inspected. LPA inspected the refrigerator and pantry cabinets and observed enough supplies of fresh perishable food for (2) days and nonperishable staples for (7) days. No expired food and no refrigerated medications were noticed.

LPA inspected the dining area and observed it clean, with all the furniture in good repair. There was a dining table and enough chairs to accommodate all the residents. Games, arts, and crafts supplies for the resident’s activities were observed in the dining area credenza. The LPA inspected the fire extinguisher mounted on the wall in the kitchen and found it was fully charged with a last service tag of 10/28/2024. The administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit.

There are (4) bedrooms and (3) bathrooms designated for residents' use. (3) resident bedrooms are private and (1) resident bedroom is shared occupancy. (2) Resident bedrooms have private bathrooms. LPA inspected all (4) resident rooms and found them clean, well-lit, and equipped with the required furniture.