Facility Evaluation Report

At 09:00am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with Staff #1, who granted access to the facility. The Administrator arrived shortly after, and LPA explained the reason for the visit.

At 09:10am LPA conducted a tour of the physical plant and observed the following:

Facility is licensed for capacity of five (5) of which three (3) may be Ambulatory and two (2) Non-Ambulatory clients. There are five (5) bedrooms designated for clients’ use. All bedrooms have sufficient lighting, properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. The facility has awake staff. Facility has three (3) full bathrooms. All bathrooms were observed to be clean and in good repair. Properly supplied with toilet paper, soap and paper towels. The hot water temperature measured at 105°F. LPA observed non-skid mats, and all trash cans in bathrooms had fitted lids to protect them from cross contamination. Extra towels and linens were readily available. No immediate health and safety concerns were observed. Facility maintains a temperature of 71°F. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of five (5) clients. At approximately 09:20am, LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to clients. There is a fire extinguisher in the kitchen, and it was last serviced on 01/27/2026. At approximately 09:25am, LPA observed medications are centrally stored and locked in the cabinet, by the kitchen area, and inaccessible to clients in care. Continue on LIC809-C