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 to, and discussed the purpose of the visit with House Manager, Garrett Mazeroll. According to the facility’s license, the facility has a maximum capacity of six clients, of whom two may be non-ambulatory.

LPA D. Roman along with facility staff toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in decent repair. Pathways were free of obstruction and slip hazards. The facility consist of 4 resident bedrooms, 2 of which have dual occupancy, and 1 office room. Resident bedrooms contained the required furnishings (closet space, drawers, night stands). 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. The kitchen area contained cooking/dining equipment. Utensils were present for resident use. There were no toxic chemicals/poisons accessible to clients. The office is locked, in a locked cabinet area medications were labeled, as required, and stored. Water temperature was measured at 101 degrees F.

Outside of the facility no pools or bodies of water were on the premises. Per Garrett Mazeroll, no firearms or ammunition are kept at the facility. Smoke alarms and carbon monoxide detectors were tested at 10:30AM, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Resident records reviewed had required documentation. Staff records reviewed had required documentation.

An exit interview was conducted with House Manager, Garrett Mazeroll, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22), and LIC 9201 were provided during the visit.