Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Annual Inspection Visit. LPA Wallace. Department will conduct Post Licensing Visit in several months for facility.

LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 112.4 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Surety Bond: RSI Insurance Company - #LSM1560989 effective since September 11, 2021. Liability Insurance: NEK Insurance - $1,000,000/$3,000,000 for Aggregate/General Liability.

Fire extinguishers last inspected on 2/10/2023 and smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication log. LPA reviewed one resident file and one staff file, including criminal record clearances. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. Fire drill was conducted on 5/16/2023 .

No deficiencies were cited during today's inspection. Exit interview and copy of report given to Administrator.