Follow-up·April 15, 2024

Licensing Program Analyst (LPA) Javina George conducted a visit for the purpose of confirming the recent changes to the facility. LPA received an updated facility sketch 10/13/23, as well as an updated approved fire clearance on 04/10/24. The facility had two additional bedrooms added, with the licensed capacity (6) remaining the same. LPA was greeted and granted entry by Administrator; Kelly Hentzen, who also has a current administrator certificate that expires on 7/14/25. At the time of the visit there were three (3) staff and five (5) residents present. The facility is licensed for a capacity of six (6), with one (1) of which may be bedridden. The facility has an approved hospice waiver for 4, of which there are three (3) residents currently on hospice. LPA conducted a tour of the interior and exterior of the single story home, and observed for the home to now consists of 6 bedrooms, 3 bathrooms, each bedroom was fully furnished. The home was clean, clutter and odor free. Inside the home bedroom # 1, 2, 3, 4, and 5 are approved for one Non-ambulatory resident. Bedroom # 6 (Master) is approved for one bedridden and one non-ambulatory resident; LPA observed for the facility food supply to meet the minimum requirements of having a 2 day supply of perishable and 7 day supply of non-perishable food items. LPA reviewed the storage and dispensing of medications and observed for them to be locked and inaccessible to residents No health and safety concerns were observed during today's visit. An exit interview was conducted, and a copy of this report was provided to Kelly Hentzen, Administrator.