Facility Evaluation Report

On 10/30/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived at the facility unannounced to conduct a required 1-year annual inspection. LPA was greeted by a staff member. LPA Lindstrom introduced herself and explained the purpose of the visit. The Care Coordinator arrived at the facility at 1:00 PM and an interview followed. The Care Coordinator joined the LPA on a tour of the facility.

The facility is licensed for a capacity of six, including six non-ambulatory only, with a hospice waiver for two. The census at the time of this site visit was five. The Administrator had an Administrator’s Certificate (#7002348740) that wa valid through 12/16/2025. The two Caregivers on duty had criminal background clearances; one of the two caregivers was not associated with the facility.

The LPA toured the interior of the facility. The entire facility is clean, orderly, and odor-free. The interior is decorated and filled with natural light. The LPA observed the required postings on the wall near the entry. The living room, dining room, and family room contained adequate seating for residents. The LPA observed three residents in the living room that were reading, watching television, or socializing with family.

The bedrooms were clean and contained the required furniture. The windows and window screens were intact. The bathrooms were clean and odor-free. The water temperature in the hallway bathroom was 108 degrees Fahrenheit, which is within the required range of 105 - 120 degrees Fahrenheit. The bathrooms contained grab bars and non-slip mats in the showers. There were extra towels, linens, and supplies in the hallway cabinets. The thermostat was set at 73 degrees Fahrenheit. Staff tested the smoke and carbon monoxide detectors, which were in working order. The fire extinguisher was serviced on 2/19/2025