Facility Evaluation Report

On 08/26/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Facility Designated Representative (FDR), Venice Andrews. FDR Andrews stated that she was the new administrator to this facility. LPA continued visit with FDR Andrews.

There was one other staff member present, Sandy Laney.

This facility is licensed to serve 6 residents who are 60 or older, all of which may be ambulatory. This facility has a dementia program on file and has a hospice waiver for 4.

Current census was 6. A brief interview with FDR Andrews was conducted.

LPA reviewed 6 resident files and 4 staff files. 6 out 6 resident files were completed and up to date. 4 out 4 staff files were completed and up to date. The Facility Representative does have an active and current administrator certificate #606909740 and expires on 04/11/2026.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Jorgenson Co on 02/27/2023.

The kitchen area was toured. LPA observed a non-perishable and perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage.

LPA observed a locked centralized stored medication cabinet located in the kitchen. 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 bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time.