Facility Evaluation Report

09/04/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. There are currently five residents in care, two are currently on hospice. Facility approved/cleared for six non-ambulatory and hospice waiver for four. Facility is a two level home with the second level not being used by residents as there is a gate at the bottom of the stairs to prevent access.

LPA and Administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. Emergency water supplies are kept in the garage. Facility has required postings throughout the building. Exits were free from obstruction.

All rooms were furnished per regulation. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 118.0 and 115.7 degrees F which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected June 2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins and sharps were located in the garage, hallway closet and under the kitchen sink and found to be secured. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. Facility conducts quarterly fire drills with the last one being conducted on 05/03/2025.

LPA conducted a review of 5 resident records. LPA conducted review of 4 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file.