Facility Evaluation Report

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by designee. Facility currently has five (5) residents in care one (1)vof which are currently on hospice. Upon arrival, LPA observed caregiver (S1) present and working in facility but not listed on Guardian roster printed 3/19/26. During LPA inspection of physical plant S1 left the facility. Designee provided LPA with S1's personal information including birthday, driver's license, and last name, but this person turned out not to be the person that was actually presen. Person actually present was staff (S2). S2 name and birthday given to LPA. Per designee, S2 does not have fingerprint clearance. LPA advised S2 cannot return to facility until S2 has fingerprint clearance ( deficiency cited, see 809D ). Licensee is aware that S2 did not have fingerprint clearance as she is the one responsible for hiring staff and associating staff to facility.

At approximately 2:40pm LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Box containing 150 eggs left outside of refrigeration inside garage, temperature today was 96 degrees F outside ( deficiency cited, see 809D ) LPA observed refrigerator to not be cool, no temperature reading available but refrigerator was leaking. Garage has two [2] refrigerators and one freezer. Per designee, the other refrigerator has also been leaking and licensee is aware. Light is broken on refrigerator in kitchen. Tile around kitchen sink is in disrepair and showing areas of black and gray substance ( deficiency cited, see 809D ). Cleaning products and laundry soaps are inaccessible to residents in care.

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required grab bars but private bath in room #1 did not have mat. Water temperature in sinks measured at 109.2 degrees F in