Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. The LPA met with Administrator Jennifer Shaffer and explained the reason for the visit.

RECORD REVIEW: Starting at 12:50 p.m., the LPA conducted a file review for all four (4) residents 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 expires on 05/25/2027.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually as required. The last fire/earthquake drill was conducted on 04/02/2026.

Beginning at 02:08 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. The following was observed:

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 slip resistant surfaces. Hot water measured within required range.