Bob & Corky's Care Home

Type of visit: Required - 1 Year

At 09:15am, on 04/30/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Backup Administrator - Shawna Harney, announced who he was and the reason for the visit. Backup Administrator and LPA conducted a full tour of the facility. This facility is a single-story residential home with four resident bedrooms (two are dual occupancy) and three full bathrooms (one is en-suite, another is en-suite with access from the hallway also making it for public/shared use, and the third is public/shared use). There is a kitchen, dining room, and living room. The living room has a fireplace with barrier for resident safety. The facility has a piano for resident use. Access to the laundry room and garage is through a locked door for resident safety. LPA noted that the backyard has seating and shade for residents and visitors. In the backyard there is a walkway connecting to the backyard of Bob & Corky's Home Care II. LPA noted fresh fruit in the kitchen for residents to enjoy freely. The facility has battery operated smoke detectors in each room that are all working, the carbon monoxide detector is in the dining room and functioning normally. LPA observed a fire extinguisher in the kitchen that was tagged current and in the green compression range, serviced on 3/9/2026. LPA tested facility hot water at 109.8°F, within regulation temperatures 105-120°F. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean with no obstructions in hallways, doorways or exits. Medications are locked in a cabinet in the kitchen and garage. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review. LPA and backup Administrator conducted a review of the annual care tool modules. No deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the backup Administrator.the state’s words, verbatim · CDSS document, Apr 30, 2026

Type of visit: Required - 1 Year

At 08:30am, on 05/08/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Backup Administrator - Shawna Harney, announced who he was and the reason for the visit. At 09:00am Backup Administrator and LPA conducted a full tour of the facility. This facility has four resident bedrooms (two are dual occupancy), three full bathrooms (one is on-suite and two are public/shared use). There is a kitchen, dining room, and living room. Access to the laundry room and garage are through a locked door for resident safety. LPA noted that the backyard has seating and shade for residents and visitors. LPA observed residents enjoying lunch outside together at a shaded table. In the backyard there is a walkway connecting to the backyard of Bob & Corky's Home Care II. LPA noted fresh fruit in the kitchen for residents to enjoy freely. The facility has battery operated smoke detectors in each room that are all working, the carbon monoxide detector is in the dining room and functioning normally. LPA observed a fire extinguisher in the kitchen that was tagged current and in the green compression range, serviced on 03/21/2025. At 09:25am in the kitchen LPA observed a steak knife in an unlocked drawer next to the refrigerator. LPA tested facility hot water at 114.1*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean with no obstructions in hallways, doorways or exits. Medications are locked in a cabinet in the kitchen and garage. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review. LPA and backup Administrator conducted a review of the annual care tool modules. Exit interview, report signed, deficiencies cited on LIC809-D, appeal rights, and report providedthe state’s words, verbatim · CDSS document, May 8, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 12:00 pm to conduct a 1-year annual visit to the facility above. LPA met with Joel Wobrock and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs are visible. The facility has EPA approved disinfectant spray and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Trash cans and wastebaskets have tight fitting covers. Physical Plant & Environment Safety: The fire extinguisher was last charged and inspected on April 4, 2024. The facility has 5 resident bedrooms, and 3 bathrooms. LPA was authorized to enter and inspect facility. The facility has a smoke and carbon monoxide detector that was tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectants, cleaning solutions and poisons are inaccessible to residents in care and are locked in hall closet . The facility has sufficient space inside and outside for activities and visiting. The facility has a secured backyard and front patio for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on April 19, 2024. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-Ambulatory, 1 of which may be bedridden in room 5 only. Hospice is approved for 2. Staffing: The facility currently employes 7 full time staff, and 1 Administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance and education requirements. Administrator Certificate expires November 21, 2024. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023 and 2024 based on anniversary date. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for signed Admission Agreements, Safeguard for property and valuables, LIC. 602A Physicians report, Appraisals Needs and Services Plan, Emergency and ID forms. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Continued 809-C Incidental Medical Services: Facility provides assistance in arranging transportation to medical and dental appointments when needed. Residents have on-call doctor that visits facility. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has residents receiving Home Health services. Exit interview conducted and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Apr 10, 2024