Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 04/05/2023. LPA met with facility administrators Jon Flint and Jen Rider (Admins).

LPA toured the facility, including 3 living rooms, kitchen, dining room, laundry room, office 11 bedrooms, 4 bathrooms, and back yard. Admin confirmed that all staff and residents have been vaccinated and boosted. In review of facility files, 4 out of 4 resident files were observed to be complete and contained all required documentation. 5 out of 5 staff files were observed to be complete and contained all required documentation. During audit of facility medication cabinet, 4 out of 4 residents were observed to have an adequate supply of all required medications. Review of emergency disaster plan did not contain mass casualty plan. Admins confirmed with LPA that they would create one.

Facility infection control 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. Hand sanitizers, soap, and paper supplies were observed to be available. Water temperature observed to be 117 *F in 2 bathrooms. Facility temperature observed to be 70*F. 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 extinguisher observed to have been inspected in March 2023. All cleaning supplies and chemicals noted to be in locked cabinets and closets. Smoke/carbon monoxide detectors were tested and observed to be functioning properly

No deficiencies cited during today's visit. This report was reviewed with Administrator Jen Rider and a copy of the signed report was provided electronically due to printer error.