Routine inspection·November 21, 2024

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the inspection care tool. LPA met with Administrator and explained the purpose of the visit. Today's census is five (5) residents in care with three (3) residents on hospice services. Facility is licensed for six (6) non-ambulatory and hospice waiver for 6. Facility is compliance to licensure. During today's inspection, LPA conducted an inspection of six residents rooms, two bathrooms, kitchen and the common areas. LPA observed outside to be free of obstructions. Based on the areas toured, LPA observed no health, safety and personal rights violation. LPA observed facility to have sharps, toxins and medications to be locked and inaccessible to other residents in care. LPA observed license and Administrator Certificate to be posted in a conspicuous space. LPA observed Administrator Certificate #7027603740 to be active with expiration date of 2/28/2026. File review was conducted for five residents and five personnel records. LPA observed initial training completed. LPA observed documentation of annual training to be pending. LPA was informed partial training has not been inputted on file for S1 and S2. Care tool completed and facility was found to be in compliance. Exit interview conducted. Signature on this form acknowledges receipt of report.