Facility Evaluation Report

On 3/24/26 LPA returned to this facility at approximately 9:30am to complete annual inspection. Previously, on 3/20/25 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 present. Person actually present was staff (S2). S2 name and birthday given to LPA. Per designee, S2 does not have fingerprint clearance but has been working for about 2 weeks at facility. LPA advised S2 cannot return to facility until S2 has fingerprint clearance ( deficiency cited, see 809D and civil penalty assessed in the amount of $100 per day for 5 days for a total of $500, see LIC421BG ). Licensee is aware that S2 did not have fingerprint clearance as she is the one responsible for hiring staff and associating staff to facility, not designee.

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 in garage to be storing food but was not cool, no thermostat so no temperature reading available but refrigerator was also leaking water out form the bottom. Garage has two [2] refrigerators and one freezer. Per designee, the other refrigerator has also been leaking and licensee is aware ( deficiency cited, see 809D ). Light is broken on