Facility Evaluation Report

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required visit. LPA Lund met with Administrator Cami Azevedo and explained the purpose of the visit. Census: 4

LPA Lund & Administrator Cami Azevedo toured/inspected the physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. 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 115 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers (2/5/2025) and smoke detectors are current and in compliance with fire safety. Carbon Dioxide monitor present. Fire drill was conducted on 2/14/2025.

LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed two residents and three staff files, including criminal record clearances and is in compliance. All staff today are associated to the facility. First aid kit was checked and is complete.

No deficiencies were cited during this visit. Exit interview held and a report given.