Facility Evaluation Report

At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with House Manager Venus Stanford and explained the purpose of the visit. Facility does not currently have an Administrator with a valid certificate. Venus has completed the training and is waiting on her Certificate. Facility has a Hospice waiver for 2 residents.

At approximately 9:20AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required supply of perishable and non-perishable food. Emergency water was present to ensure facility can be self-sufficient for 72 hours. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills monthly.

At approximately 10:00AM, LPA reviewed 4 of 4 resident files. 2 of 4 resident files contained reappraisals that were conducted within the last 12 months. Documentation of a physician visit within the last 12 months was present.

At approximately 12:00PM, LPA reviewed medication records.

Due to time constraints, LPA will return at a later date to complete this inspection.