Facility Evaluation Report

On 06/29/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA met with Facility Designated Administrator (FDA), Saudia King and explained the purpose of the visit. There were two other staff members present, Staff member (SM), India King and Lillie King during the course of this visit. This facility is licensed to served and accept up to 6 residents who are deemed to be ambulatory only. This facility is also vendorized to accept and retain Level 3 residents at this time.

A brief interview with the FDA Whitaker was conducted.

LPA reviewed 5 resident files. 5 out of 5 resident files have been current and up to date. LPA reviewed 3 staff files. 3 out of 3 staff files are current and up to date. The FDA has an active and current administrator's certificate #6020044735 and expires on 08/30/2024. LPA reviewed 2 out 2 resident P&I funds.

Carbon monoxide and smoke alarms were tested and were in working condition.

The kitchen area was toured. LPA observed a sufficient amount of 2-day perishable and 7 day non-perishable food supplies in the refrigerator and cabinets. Fire extinguisher was present and was serviced on 02/21/2024. Knives were observed to be locked in a kitchen cabinet and made inaccessible to the residents at this time.

LPA observed a locked centralized stored medication located in the kitchen cabinet. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.

A tour of the 3 bedrooms was conducted. Furniture and furnishings were observed to be in good repair and able to meet the needs of the residents at this time. A staff bedroom was also toured.