Facility Evaluation Report

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by designee, Administrator Cheryl Davidson arrived later. Facility currently has seven (7) residents in care none of which are currently on hospice. Administrator certificate #7011528735 expired 5/15/26. However, Administrator showed LPA the proof of delivery and USPS receipt for mailing off certificate renewal package. Package mailed in on 5/5/26. LPA verified with Officer of the Day at CCL that Cheryl Davidson is on the Pending-Renewal.

At approximately 10:15am LPA and designee toured the building and grounds. LPA and Admin discussed having at least a 2 day supply of perishable and 7 day supply of non-perishable food. Currently, facility does not have quantity of food that would allow for 2 day supply of perishable and 7 day supply of non-perishable food for seven residents ( deficiency cited, see 809D ). LPA did not observe any disinfectants or cleaning supplies accessible to residents in care. All other cleaning products and laundry soaps are located with staff. Residents ask staff for laundry pods in order to do their laundry. Staff then give one pod per load of laundry. .

All bedrooms were equipped with lighting, night stand, and chest of drawers. Extra hygiene products and linens were available. Water temperature in sinks measured at 122 degrees F in the bathroom used by staff and residents, 118.5 degrees F in room #1, and 113.9 degrees F in the and 126.3 degrees F in the back bathroom. Two temperatures are not within the allowable range of 105 to 120 degrees F. Facility had maintenance person present and they immediately lowered temperature. LPA measure water again in