Facility Evaluation Report

On 12/5/2023 at 9:30am, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct an Annual 1-year required inspection. LPA met with Cheryl Reed, Program Coordinator, and explained the reason for the visit. The facility's fire clearance was approved for 60 ambulatory, 30 non-ambulatory and 10 bedridden.

LPA inspected the facility with Program Coordinator, which included but not limited to the bathrooms, kitchen, common areas, and the outside area of the facility. LPA observed the facility to be free of odor, clean and in good repair. Outdoor space is provided and is free of hazards. There is a comfortable room temperature of 73 degrees Fahrenheit for clients in care. Clients bring their own lunches and snacks to facility. The hot water temperature in the shared bathroom measured 120.0 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 fire alarms found to be in working order. Centrally stored medications, toxins and sharp objects were locked and inaccessible to participants. Fire extinguisher last services 10/19/2023. Fire drills are conducted once a month. First aid kit was checked and is complete.

LPA reviewed four (4) staff files and all have current first aid & CPR certification. LPA reviewed nine (9) participants and all were current and complete.