Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 06/29/2022 at 10:40am. LPA met with facility Administrator Megan Miller (Admin). LPA toured the facility, including front office, medicine room, food storage room, 3 living rooms, dining room, activities room, library, staff offices, medicine room 10 bathrooms, 2 designated smoking areas, and 10 resident rooms.

All staff members observed to be wearing masks. Admin confirmed that all residents and staff have been vaccinated. Facility Mitigation plan has already been submitted and approved. 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. Facility water temperature observed to be 111.7*F. Fire extinguisher noted to have received inspection in May 2022. Smoke detectors observed to be operational. Facility observed to have 2 days supply of perishable food and 1 weeks supply of non-perishable food.

Facility noted to possess a 30-day supply of PPE. Facility observed to have designated entry point. Staff took LPA's temperature, and screened for symptoms. All restrooms observed to be stoked with paper towels and lidded trash cans. Hand washing signs observed in all bathrooms. Social distancing signs observed as posted throughout facility in all public areas.

No deficiencies cited during visit. This report reviewed with Facility Administrator Megan Miller and a copy of the signed report was provided.