Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 11/15/2021 at 01:06pm. LPA met with facility Lead Staff Member Rona Victory (S1).

LPA toured the facility, including living room, kitchen, dining room, 4 client bedrooms, 3 bathrooms, back yard, storage room, and staff office. All staff members observed to be wearing masks. S1 confirmed that all staff and residents have been vaccinated.

Facility Mitigation 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 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. Fire extinguishers observed to be inspected in 2021. Facility fire alarm tested and observed to be in working order. Facility water temperature observed to be 119.1 *F.

Facility observed to have designated entry point. Staff took LPA's temperature and screened for symptoms. 30 day supply of PPE observed. All restrooms stocked with paper towels. Hand washing signs not observed to be in all bathrooms. Social distancing signs observed to be posted in all public areas. The facility is currently accepting visitors inside the facility, including residents' bedrooms.

No deficiencies cited during today's visit. This report was reviewed with Lead Staff Member Rona Victory and a copy of the signed report was provided.