Facility Evaluation Report

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility to conduct a annual inspection. LPA met with Administrator Heather McClosky and explained the purpose of the visit. Davis guest home VI is a 5 bedroom 3 bath with 9 residents currently residing in the facility.

Physical Plant was inspected including but not limited to bathrooms, bedrooms, kitchen, common areas, exteriors, and evacuation route gate. Facility is clean, traffic areas are well lit and free of obstruction Bathrooms have hardware in good repair, Bedrooms have required furniture and furnishings. Kitchen has adequate storage for 2 days perishable and 7 days non perishable food, LPA gave guidance to dust, check for dents and dates, and generally inventory the nonperishable foods every 6 months or so. Foods outside their original container should be stored with the label or given a date for the start of the storage. Common areas and exteriors are free of trip hazards and have space for activities. evacuation route gate swings freely and latches closed.LPA was told small building on the east side of the property was storage that had no key. Fire extinguishers are dated 8/7/25. first aid kit is has all required items, smoke/co alarm is functional.

5 client records were checked at random. tb screenings, signed admission agreements, 602 medical assessments are present and up to date. LPA gave guidance the needs and services plans are the place to outline the specific care being provided and unique challenges to the residents, usually addressing whats in the 602 or functional capabilities assessments. 5 Staff records were reviewed: health screenings, fingerprint clearance, initial training documents present and up to date. LPA gave guidance that continuing training schedule should be reviewed for the timing and topics. Administrator files were reviewed, infection control plan, evacuation plan, facility posters, insurances, and control of the property documents present and up to date.

No citations issued with this visit, a copy of the report was read and given to the administrator. Exit interview conducted.