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25 | At 11:00 a.m. on 11/06/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. No immediate health and safety hazards were noted during the time of the visit.
At 8:45 a.m. today prior to the visit, a file review was conducted of facility documents including but not limited to the Plan of Operations, Dementia Care Plan, Mitigation Plan, Liability Insurance, Facility Application, Facility Sketch, Fire Clearance, Facility Profile, and Personnel Report. A current copy of the facility’s liability insurance was obtained at 12:30 p.m. today.
The facility was last visited on 09/08/2022 for a case management visit. It is a single story building with 6 bedrooms, 2 bathrooms, kitchen, laundry room, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which five (05) may be non-ambulatory and one (01) bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06).
At 11:15 a.m. today, LPA obtained documents including but not limited to the staff roster, resident roster, and resident files for review.
At the main entrance, LPA observed a visitor log as well as postings including but not limited to the facility’s visitation policy, non-discrimination notice, a blank copy of the admission agreement, resident rights, rights of resident councils, facility sketch with evacuation routes clearly labeled, and contacts for the Ombudsman and confidential complaints.
The facility has 6 bedrooms. 2 bedrooms are designated as staff rooms. The staff rooms were locked and free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.
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