Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced pre-licensing inspection visit, and met with Administrator (ADM) Brian Brownell.

LPA toured the facility inside and out with ADM. Personal Rights posters and Administrator Certificate were observed posted at facility.

Living room, kitchen, dinning room, family room and two restrooms were inspected. Three shared resident bedrooms, garage, and laundry room were inspected. One staff live-in rooms was observed in facility. First Aid Kit was observed in the facility. Non-skid mats and Bar were observed in restrooms. Cloth towels were observed in restrooms and kitchen. All the bed rooms were observed with screens.

Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 71 degree F, and hot water temperature was at 115 degree F in facility. Temperature of freezer was observed at -01 degree F, and temperature of refrigerator was observed 40 degree F.

Fire extinguisher was serviced on 2/9/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. One small storage room was observed at the backyard.

LPA discussed the Infection Control Plan with ADM. Component III orientation was conducted with ADM. Exit interview was conducted with ADM. This report was provided to ADM for signature.