Facility Evaluation Report

On 9/20/23 at 2:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Debra Pickens and explained the purpose of the visit. Care staff Kiva Potlock arrived and administrator gave permission for care staff to sign the report. The facility’s fire clearance was approved for 4 ambulatory clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 2 total bedrooms which 2 bedrooms are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in kitchen sink measured at 117.5-degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of one-week supply of non-perishables and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 7/08/22. First aid kit was observed to be complete. Fire drill was last conducted on 9/04/23.

At 2:45 p.m., 3 of 3 clients’ records were reviewed and were complete. At 3:30 p.m., 2 staff records were reviewed, and 2 of 2 have current first aid training and areassociated to the facility. A sample of 1 client’s medications were reviewed.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/27/23: LIC 610E Emergency Disaster Plan

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.