Facility Evaluation Report

Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct an Annual Required inspection and met with Licensee, Laarni Lockerbie & Administrator, Armela Marie Monte. Facility is single story with 5 bedrooms & 3 bathrooms with an approved Fire clearance for 6 Non-Ambulatory residents & Hospice Waiver for 2. There is a total of 5 residents, 1 under hospice care & 3 with diagnosis of dementia.

LPA initiated a tour of the facility at approximately 8:25 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Cleaning supplies and toxins observed in locked cabinets in garage & under kitchen sink not accessible to residents in care. Resident’s rooms were furnished per regulation. Water temperature in bathrooms measured at 118 degrees F and 121.2 degrees F, not within the range of 105 to 120 degrees F allowed per regulation; although Administrator provided proof new water heater was just installed prior day and is adjusting (LIC9102 TA). Resident bathrooms had required slip resistant mats and grab bars. Extra hygiene products and linens were available. Cabinet containing cleaning supplies in garage was locked. There was enough lighting in all common areas, resident rooms, and hallways. Fire extinguisher was last inspected 3/4/2025. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational.

At approximately 9:15 AM, LPA reviewed 5 of 5 resident records and found 5 of 5 residents have current physician’s reports or care plans. 5 of 5 resident records contained current and signed admission agreements and physician’s orders on file. Continue on LIC809C