Facility Evaluation Report

Licensee Program Analyst Jason Lund arrived at the above address unannounced to conduct an annual/required inspection and met Licensee/Administrator Maria Payla. LPA Lund explained the reason for the visit. Census 4. 6 non-ambulatory clients.

LPA Lund & Licensee/Administrator Maria Payla walked the facility including common areas, resident bathrooms, kitchen, dining room, laundry, storage, and outside yard area. The facility is clean and in good repair and no odors were detected in areas toured. No hazards were noted in courtyard areas, hallways, doorways, etc. No equipment was stored in public areas. Fixtures and furniture all appear to be in good condition. Cleaning solutions are stored separately from food. Handrails are present in all shower and toilet areas, are secured. Room temperature was comfortable in facility. There are no bodies of water on the premises.

No deficiencies were observed at this time.

Exit interview conducted with Licensee/Administrator Maria Payla and copy of this report was left.