Facility Evaluation Report

Licensing Program Analyst (LPA) David Roman conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself, and discussed the purpose of the visit with Administrator, Hugrstine Foster. According to the facility’s license, the facility has a maximum capacity of four clients, of whom all are ambulatory.

LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 110 degrees F.

No pools or bodies of water on the premises. Per Licensee, no firearms or ammunition are kept at the facility. Smoke/carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present. First aid kits were complete and readily accessible.

Resident records reviewed had required documentation. Staff records contained required documentation.

An exit interview was conducted with Administrator, Hugrstine Foster, to whom a copy of this report and the Licensee/Appeal Rights were provided during the visit.