Health check·March 20, 2024

On 3/20/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a quarterly health and safety check. LPA Jensen met Carlin Robertson and explained the purpose of today's visit. LPA Jensen confirmed with the Director of Resident Services that there has not been any infectious condition outbreaks. The facility has recently had a leadership change and Carlin Robertson has been appointed as the new Executive Director. LPA Jensen provided technical assistance related to change in Administrator. Documentation to initiate the Administrator change will be sent by 3/25/24. During the course of an interview, Executive Director Carlin confirmed she spends in excess of 40 hours per a week at the facility. LPA Jensen reviewed 3 staff files and determined that 3 of 3 staff members have a current first aid certification. LPA Jensen reviewed 3 resident files. LPA Jensen observed 3 of 3 resident files to have current Physician Reports and current Needs and Service Plans. LPA Jensen toured the facility and observed clients engaged in group activities. Freshly baked apple pie was being served for snack. LPA Jensen observed the food supply and determined there was in excess of a 2 day supply of perishable food however there did not appear to be a 7 day supply of non-perishable food. LPA Jensen interviewed the Executive Director who advised that facility is able to transfer food from the Independent Living facility that is adjacent to this facility and under the same management group. Technical assistance was provided with a recommendation to maintain a 7 day food supply on site. Based on the incident reports received over the last quarter the facility has been meeting reporting requirement timelines. LPA Jensen inspected the medication room and observed multiple systems for documenting when a medication was started. Technical assistance was provided with recommendation to consolidate recording efforts. No deficiencies were issued during the course of this visit. An exit interview was conducted and a copy of this report will be emailed.