Facility Evaluation Report

Licensing Program Analyst (LPA) Noel Wolf Petersen arrived unannounced to conduct a one year annual/required inspection. LPA met with Administrator Mary Jefers and explained the reason for the visit. Census:6

LPA and Administrator toured/inspected the physical plant including but not limited to the kitchen, dining room, six residents bedrooms; three 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. Fire extinguishers (12/1/2025) and smoke detectors are operational and in compliance. The facility also has a sprinkler system.

LPA observed centrally stored medications are kept locked and inaccessible to residents. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. Hot water temperature was measured at 112 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees.

LPA reviewed five staff & five clients files are in compliance. LPA gave guidance that four hours of topical restricted health care condition training (insulin dependant diabetes) be added to the annual training for as long as a resident has that condition in the facility(2 residents).

LPA reviewed administrator files: present and up to date.

No deficiencies were observed during today’s visit. Exit interview held with Administrators Debrora Mensonides, Tena Minders, Mary Jefers and report left. LPA asked for a LIC 200 administraotr change.