Facility Evaluation Report

On 04/22/2024 at 10:05am, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Annual 1-year required inspection. LPA met with Mary Jane Mejia, Program Manager, and explained the reason for the visit. The facility's fire clearance was approved for 30 ambulatory.

LPA inspected the facility with Program Manager, which included but not limited to the bathrooms, kitchen, outside area, and common areas of the facility. LPAs observed the facility to be free of odor, clean and in good repair. There is a comfortable room temperature of 70 degrees Fahrenheit for clients in care. Grab bars mats were observed in bathrooms and throughout the facility. Clients bring their own lunches and snacks to facility. The hot water temperature in the shared bathroom measured 102.8 degrees. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed. Carbon monoxide and smoke detectors found to be in working order. Centrally stored medications, toxins and sharp objects were locked and inaccessible to clients. Emergency disaster plan last updated 6/5/2022. Fire extinguisher last services 6/2/2022. Fire drill last conducted 4/15/2024. First aid kit was checked and is complete.

LPAs reviewed five (5) staff files. LPAs reviewed six (6) clients.