Facility Evaluation Report

Licensing Program Analysts (LPAs), Farhaan Sarangi and Christi Coppo arrived unannounced at Spring Lake Village for the purpose of conducting a Case Management-Annual Continuation. LPAs was greeted at the door by back-up Administrator, Dan Skillman, and was granted access into the facility. Health Services Director greeted LPAs at the facility as well. LPAs were directed to the RN Supervisor.

During the Case Management-Annual Continuation, LPAs reviewed 5 of 5 staff files and found those files to be appropriate during the inspection. LPAs reviewed the Medication Orders and found those to be appropriate during the inspection. LPA reviewed resident records and found those to be appropriate during the inspection. LPAs interviewed 5 of 5 residents in care and 5 of 5 staff members in care. First Aid Certificates were not available for viewing (See LIC 9102-Technical Advisory). LPA advised facility to send a copy of ALL First Aid/CPR cards to the LPA. LPA requested the following documents to be sent:

LIC 400- Affidavit regarding Client Cash Resources

First Aid Certificates for 5 staff members

No deficiencies were cited during today's Case Management-Annual Continuation. Exit interview was conducted and a copy of this report was given to the Health Services Director.