Facility Evaluation Report

Licensing Program Analysts (LPAs) Simi Rai and Santino Fortes conducted an unannounced annual inspection, and met with Administrator (ADM) Lori Mohassel. LPAs observed 3 staff and 6 residents at the facility. ADM stated there were 0 residents under Hospice services.

LPAs toured the facility inside and out including: kitchen, living room, family room and 1 staff room, 6 resident rooms and 2 restrooms.

LPAs observed 6 out of 6 exit doors in the resident rooms had secondary locks on the doors and was not kept free of obstruction wherein the door was not able to open without staff opening the locks with key. LPAs observed locked stoppers on the sliding door railings which restricted the sliding doors from opening. Staff had access to the keys to unlock door stoppers and secondary locks and were able to unlock all the doors during the visit. Licensee and ADM understood to keep all doors free of obstruction.

LPAs observed 1 out of 6 beds had attached full bed rail in R1's room. Licensee and administrator stated that R1 was not receiving hospice services. Licensee and ADM will work with R1's primary care physician to obtain written order to use 1/2 bed rail for mobility.

Restrooms observed to have non-skid flooring. LPAs observed perishable food supply of at least two days and non-perishable food supply of at least seven days. Refrigerator temperature was observed at 32 degrees F and Freezer temperature was 0 Degrees F. The front yard and backyard of the facility was also inspected. LPA observed one exit fence leading out of the facility was held up with a plank of wood. ADM stated they will repair the fence is not able to close properly. No outside storage shed was observed. LPA observed Facility License and Resident Personal rights were posted.