Facility Evaluation Report

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA met with staff and later with one of the Administrator, Kim Anderson. Reason for the visit was explained.

At 10:45 a.m., the LPA along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards. Facility is fire cleared for six (6) non-ambulatory rooms, of which one (1) may be bedridden. The facility has a hospice waiver for six (6). The LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service.

Facility has six (6) non-ambulatory resident bedrooms, one (1) staff room and one (1) room used for staff office/rest area. BEDROOMS: The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms observed appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. The staff bedroom and office/rest area observed locked during today's visit. BATHROOMS: There are six (6) total bathrooms, four (4) for resident use, one (1) for staff use and one for guests. All bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The hot water was measured within 105 - 120 degrees Fahrenheit . KITCHEN: Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. COMMON AREAS: Furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. (Continue to LIC809c).