1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | Licensing Program Analyst (LPA) Anthony Tuck arrived to conduct an unannounced annual inspection on 01/28/2022. LPA performed a risk assessment call prior to entry. LPA met with Administrator Ermelinda Siebenthal and explained the purpose of the visit. Ermelinda Siebenthal is the Administrator and holds certificate #0001130740 that expires on 06/12/2023.
This facility is a single story building licensed to serve six (6) non-ambulatory residents with a hospice waiver for 2 residents at any given time. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.
LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (115.2) degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 03/10/2021. Thermostat observed at (75) degrees Fahrenheit. LPA observed linens cabinet in hallway.
LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed staff associations to the facility. First aid kit was checked and is complete.
The following forms need updating and were collected on 01/23/2022
LIC 500, LIC 9020, Certificate of liability insurance
There were no deficiencies were found during today's visit on 01/28/2022. Exit interview held with Ermelinda Siebenthal and a copy of report given at the conclusion of the visit. |