Bob & Corky's Care Home V

Type of visit: Required - 1 Year

At 12:15pm, on 4/2/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Shawna Harney, announced who he was and the reason for the visit. Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with five resident bedrooms (one is dual occupancy), a half public bathroom, and three full bathrooms (two are en-suite and one is for public use). There is a full kitchen and a living room with dining space and a protected fireplace for resident safety. Access to the office area and garage is through a locked door for resident safety. The laundry area is behind accordion doors in the hallway and chemicals are locked in cabinets for resident safety. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. There is fresh fruit and snacks in the kitchen for residents to enjoy. The facility has battery/wired dual smoke/carbon monoxide detectors in each room that are all working. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 3/9/2026. LPA tested facility hot water at 120*(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. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. Staff and client files are locked in the enclave of the dining room. LPA conducted a staff and resident file review. LPA and Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 2, 2026

Type of visit: Required - 1 Year

At 08:15am, on 04/17/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Shawna Harney, announced who he was and the reason for the visit. Administrator and LPA conducted a full tour of the facility. This facility has five resident bedrooms (one is dual occupancy), three full bathrooms (two are on-suite and 1 is for shared use), and one half bathroom near the kitchen. There is a kitchen and living room with dining space. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy freely. The facility has battery operated smoke/carbon monoxide detectors in each room and throughout the facility that are all working. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 03/21/2025. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean. Medications are locked in a cabinet in the garage and kitchen. Staff and client files are also locked in the garage. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. LPA and Administrator conducted a review of the annual care tool modules. No citations given at this time. Exit interview, report signed, and report provided.the state’s words, verbatim · CDSS document, Apr 17, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 1:30 pm to conduct a 1-year annual visit to the facility above. LPA met with Shawna Harney, Administrator 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 stored at house 2. 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 garage cabinet. 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, 2025. 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 4. Staffing: The facility currently employes 6 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 5 resident files for signed Admission Agreements, Safeguard for property and valuables, LIC. 603 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. (809-C) 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 upon request from Licensee 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 24, 2024