Facility Evaluation Report

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 1:45 p.m., the LPA met with Administrator Jennifer Shaffer and explained the reason for it visit.

RECORD REVIEW: Starting at 1:53 p.m., the LPA conducted a file review for one (1) resident and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. Administrator’s Certificate is pending.

At 2:20 p.m., the LPA along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards.

KITCHEN: The LPA observed the kitchen and dining area. Knives are stored locked and inaccessible inside a kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 2:28 p.m., hot water measured at 105.3-degree Fahrenheit.

BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water measured within required range. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing.