Facility Evaluation Report

On 02/2/24 at 10:00am, Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson arrived unannounced to conduct an Annual 1-year required inspection. LPAs met with Jeremy Riley, Direct Care Support, and explained the reason for the visit. Jechane Reyes, Manager Director arrived at 10:25am. The facility's fire clearance was approved for 25 ambulatory and 5 non-ambulatory.

LPAs inspected the facility with Program Director, which included but not limited to the bathrooms, kitchen, 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 67 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 87 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 09/30/2022. Fire extinguisher last services 08/08/2019. Fire drill last conducted 01/03/2024. First aid kit was checked and is complete.

LPAs reviewed seven (7) staff files. LPAs reviewed six (6) clients.