Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Gideon Imeh and explained the reason for the visit.

The facility is licensed to serve as an Adult Residential Facility for 4 ambulatory clients in the age range of 18 through 59. It is located in a residential and it is a one story family home, which includes 4 client bedrooms, 2 bathrooms, living room, kitchen, attached garage, front yard and back yard.

LPA toured the facility with Gideon Imeh and observed the following:

The facility is in good repair in the outside. Kitchen was observed clean, sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Refrigerator and freezer do not have a thermometer and LPA was unable to tell the temperature. Dining room and living room have sufficient sitting area. Living room was observed with a cover fireplace. Four client bedrooms were observed to have sufficient lighting, the required furniture and bedding supplies. Room #1 was observed with a hole of about a baseball in the entry wall, Room #3's door was observed with a hole the size of about 6in by 6in, door panel for storage was observed bend and dislodge from the door frame, bathroom #2 was observed with toilet's water tank lid missing, and a hole on the wall next to the door the size of about a baseball. Room #4 does not have a door. Outdoor area does not have a shaded sitting area. No large bodies of water were observed.

Fire extinguisher was observed in the kitchen. Smoke/carbon monoxide detectors were tested and are in working condition.

Medication was reviewed for 4 clients, P&I money was reviewed for 2 clients. Files were reviewed for 3 clients, client #1-2(C1-C2) did not have a copy of admission agreement, C1-C3 did not have a copy of physician's report, and C2-C3 did not have a TB test on file, and client #4(C4)'s file was not available for review. Files were reviewed for 3 staff and files for staff #3-4 (S3-S4) were not available for review. Last fire drill was conducted on 9/29/23. (CONTINUED ON LIC 809C)