Facility Evaluation Report

At 9:15 AM on 9/9/2021 Licensing Program Analyst Hansen arrived unannounced to conduct a required Annual 1 yr. Infection Control inspection and was met by Staff Monette Temple who called Administrator to inform of DDS/CCL LPA Hansen. Administrator Eric Moessing arrived approximately 20 minutes later and continued inspection with LPA. Facility has a capacity of 15, at this time census is 14 with a hospice waiver for 6 although only 3 on hospice at this time.

LPA arrived at the facility and had temperature checked and logged into visitor’s binder. The facility was a comfortable temperature, free from obstructions and was well lit. There was a sufficient amount of perishable and non-perishable foods in the kitchen and in locked storage room off of the kitchen . Extra hygiene products and linens were available and required bathmats and grab bars were observed. Water temperature in resident's bathrooms measured 116.4 degrees F and 118 degrees F which are within acceptable range of 105 to 120 degrees F. Cleaning products and other toxins are located in locked cabinet under kitchen sink and in locked laundry room. Knives are kept in a locked cabinet in the kitchen. Medications are centrally stored and locked in kitchen cabinet at time of inspection.

Fire extinguisher was last inspected August 18, 2021. Facility has a hard wired smoke alarm system that is maintained by a vendor and inspected by the local fire department. Facility's last service was conducted June, 2021. Last Disaster Drill was conducted on 6/2021. Auditory alarms were functional at the time of visit.

S1 has required 1st Aid and CPR certificates, with expiration date of 8/1/2021. S2 also has required 1 st Aid and CPR certificates, with expiration date of 3/10/2023 and, S3 has 1 st Aid and CPR certificate with expiration date of 7/10/2023.