Facility Evaluation Report

On 2/19/26 at 10:30 AM, Licensing Program Analyst Noel Wolf Petersen arrived unannounced to conduct the annual inspection. They were met by staff and explained the purpose of the visit. This facility has 4 clients, no resticted conditions at this time. 1 client has metformin controlled diabetes. wavier for delayed egress.

LPA's conducted a Physical Plant inspection including but not limited to the resident bedrooms, resident bathrooms, kitchen, hallways, evacuation routes, and the exterior. The required furnishings and furniture are present, the passages are unobstructed and well lit, the facility is clean and in good repair.

Tthe sharps and toxics and medications are in locked containers and away from the residents in care. The air temperature is 74. The water temperature in the residents bathrooms was measured within the required range of 105-120*f, bathroom hardware is functional. the required postings of evacuation routes, administrator license, ombudsman poster, client rights poster, and federal workers rights poster are in the staff room. LPA gave guidance that the emergency and abuse reporting contact phone numbers should be moved into the entryway The last fire drill was conducted , within the quarterly timing.

A review of four (4) client files contained up-to-date needs and services plan, admission agreements, and physicians reports for each client.

A Medication review, conducted with 2 random clients medications and MAR were found to be fully documented and in order