Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit and was greeted by the manager. The Administrator arrived at 12:45 pm. The facility is licensed as an adult residential facility to serve four ambulatory residents and staff confirmed there are four residents living in the facility.

LPA and the manager began the tour of the facility at 12:00 pm until 12;40 pm. LPA observed the following:

Living Room – LPA Spaeth observed the living room comfortable seating and a television.

Kitchen/Dining room - The dining room and kitchen are combined. LPA Spaeth observed a seven-day supply of non-perishable food and a two-day supply of perishable foods. The fire extinguisher is located in the kitchen. LPA observed the knives, first aid kit and residents' medications were locked in a kitchen cabinet. The cleaning solutions were locked in a cabinet underneath the sink. The dining area contained a dining room table and chairs The water temperature was tested at 12:40 pm and the temperature was 110.0 F.

Bathroom – LPA Spaeth observed the bathroom contained hand soap, paper towels, and a trash can.

Bedrooms – LPA Spaeth observed there are four client bedrooms in the facility. The bedrooms contained bed, linens, night stand, chair, chest of drawers and night lamp.

Staff Room – LPA observed the staff room was locked.

Laundry Room – LPA Spaeth observed the laundry room was locked and contained a washer and dryer along with the laundry detergent.

Garage - LPA observed the emergency water supply, PPE supplies and an additional refrigerator with additional food