Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 4/9/25 at approximately 2:00pm, and met with Administrator Janine Sorenson.. Caregivers notified Licensee/Administrator that the LPA had arrived to conduct an inspection.

There currently are six (6) residents in care. LPA observed two caregivers on duty.

LPA reviewed six (6) resident files. All files were complete.

LPA reviewed five (5) staff files. LPA reviewed staff training. LPA reviewed staff's first aid and CPR certifications. All staff have criminal record clearance as required.

Facility has a fire clearance approval for 6 non-ambulatory of which 1 may be bedridden, in room #2 only. Fire extinguishers were serviced and tagged as required. Emergency fire & disaster drills are conducted as required.

Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements.

Hot water was measured at 113.3 degrees Fahrenheit. The exits were cleared and unobstructed. Food supply was sufficient. Sufficient furnishings throughout the facility. Sufficient lighting in all resident rooms, bathrooms, and common areas.