Facility Evaluation Report

At 10:45am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. LPA met with Staff #1 (S1), who granted access to the facility. S1 contacted the Administrator and LPA explained the reason for the visit. The Administrator informed LPA that he is unable to come to the facility and designated S1 to sign for the report.

A tour of the physical plant was initiated at 10:50am and the following was observed:

The facility is cleared for four (4) Ambulatory clients. Client Group Served in Developmentally Disabled (DD).

Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. There is adequate supplies of two (2) day perishable and seven (7) day nonperishable foods. Dining ware is also available to accommodate a maximum capacity of four (4) clients. Sharp knives/objects and medications are kept in the kitchen cabinet and observed to be locked and inaccessible to clients in care. There is a complete first-aid kit by the cabinet with all required supplies and with the first aid manual.

Bedrooms: The facility has five (5) bedrooms. Four (4) bedrooms are designated for clients’ use. All bedrooms are furnished with beds and dressers and required bedding and linen. The bedrooms have sufficient closet space. Bedroom #4 is designated for live-in staff.

Bathrooms: Facility has two (2) bathrooms. Bathrooms have soap and paper towels. Extra towels and linens are readily available. The hot water delivered in the client bathrooms measured at 105.1°F.

Common Areas: The facility maintains a comfortable temperature of 72°F. LPA observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of four (4) clients. There is a functioning telephone on the premises. Continue on LIC809-C