Facility Evaluation Report

On 6/19/203, Licensing Program Analysts (LPAs) M. Medina conducted an unannounced Annual Required Inspection. LPA Medina introduced self and allowed entrance by Direct Care Staff, Patrick Nankil contacted by telephone and he arrived a short time later to conduct inspection.

Currently, 4 residents are in placement. All residents were present at time of inspection.

Facility tour conducted with Direct Care Staff. Facility observed to be well lit, clean and odor free. All common areas have adequate seating available. Resident bedrooms toured, all bedrooms observed to have required furnishings. Bathrooms toured, showers observed to have non-slid mats and grab bars. Water temperature during facility inspection measured at 108 degrees F. Kitchen toured, all sharps observed to be locked and secured in pantry. Facility observed to have a 2-day supply of perishable and 7-day of non-perishable available. Medication observed to be locked and secured in medication cabinet and observed to be administered as ordered. Smoke detectors and carbon monoxide detector observed operational during inspection. Fire extinguisher present with a purchase date of 10/04/22.

Outside of facility toured. All exits open free of obstruction. Perimeter of back yard is secured with a fence and free of obstruction.

Exit interview conducted. No deficiencies cited.