Routine inspection·April 16, 2025

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the caregiver. The Administrator was called and LPA stated the purpose of the visit is to conduct an annual inspection. The facility is licensed for five non-ambulatory residents and one bedridden resident. LPA confirmed there are five residents in the facility. LPA and the caregiver toured the facility at 10:15 am until 10:55 am. Kitchen - LPA Spaeth observed a two-day supply of perishable food and a seven day supply of non-perishable food. The knives were locked in a kitchen drawer. The cleaning solutions were locked underneath the kitchen sink. The fire extinguisher is located near the kitchen and is operable. Common Areas –The living room and dining room are combined and contained comfortable seating along with dining room table and chairs. The family room contained comfortable seating and a television. Residents’ Rooms – The rooms contained a bed, linens, night stand, lamp, chest of drawers and a closet. Continued on 809-C Bathroom – The two bathrooms contained grab bars, slip resistant mats, paper towels and a covered trash can. The water temperature was tested at 10:55 am and was 116.4 degrees F. Backyard –The backyard contained a shaded area. The gate leading from the backyard to the front yard was not locked. Medications - The medications were locked in a cabinet located in the living room. The first aid kit was also locked in the cabinet. Laundry Area – The washer and dryer are located in a laundry area. The laundry detergent was located in the locked garage. Smoke/Carbon Monoxide Detectors - The smoke/carbon monoxide detectors were tested at 10:56 am and were properly working. Egress System -LPA Spaeth observed the egress system was working when exiting the facility. Residents’ Records -LPA reviewed residents' records at 11:15 am until 12:15 pm. LPA observed resident files were incomplete. LPA Spaeth spoke to the Administrator by phone and explained to the Administrator what documents were needed in the residents' files. Staff Records - LPA reviewed five records at TIME until TIME. Based upon LPA's observations, the following deficiencies were cited (see 809-D page). Exit interview conducted, appeal rights discussed and a copy of the report was given.