Facility Evaluation Report

12/15/2022 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct their scheduled pre-licensing inspection. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask, gloves. LPA met with licensee Cassie Berry and administrator Christopher Bell and explained the purpose of the visit.

Comp 3 was presented by LPA to licensee and administrator during the visit.

The fire marshal has approved the fire safety inspection request. The facility is licensed for a total capacity of 6 non-ambulatory residents.

The inside of the facility was observed to be in good condition and repair. The facility has four (4) bedrooms, and two (2) bathrooms. LPA observed 1 dining table with proper seating for residents. LPA observed 3 recliners and 1 easy chair with ottoman in the common area.

The hot water registered at 108 F degrees which met the requirement for licensing within a range of 105 - 120 degrees F.

Food storage meets Title 22 regulation requirements. Plates, utensils, pots, and pans were in place during the inspection. Dishwasher, stove, microwave and refrigerator were all present and working.