Facility Evaluation Report

On 06/05/2025 Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct a Post-Licensing Inspection of facility and was welcomed by staff Alberto Lopez. Staff contacted Administrator Kelly Eriksen who arrived during inspection. Facility is a single-story building with 6 bedrooms, and an approved fire clearance for 6 Non-Ambulatory of which 1 may be bedridden. Hospice waver has been granted for 2. There are currently 6 residents with 1 using Hospice services during the time of this inspection.

Facility tour/inspection began at 8:10 AM:

LPA toured the indoor and outdoor portions of facility on 6/05/2025; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. The facility has special care plan of operation and programming for residents with dementia. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing, as well night lights for residents.

There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations. Food is available for residents any time of the day. Cleaning products, sharp items, other toxins and chemicals are kept out of resident access and found secured and stored in the kitchen, laundry room, and shed. There was a supply of cleaners, hygiene products and paper products available for residents. Resident bathrooms had required slip resistant mats and grab bars. Hot water temperature measured between 111.7 degrees F and 115.8 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathroom faucets. All bathrooms at the facility were supplied with paper towels and hand soap.