Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 10:35 am. LPA Smith knocked at door, but no one answered. LPA Smith called and briefly spoke with the administrator at approximately 10:43 am. The administrator revealed that there are no staff or residents currently residing in the facility. The administrator arrived and LPA Smith disclosed the purpose of the visit.

The facility is a single story building with seven (07) bedrooms, and two (02) bathrooms. It has an approved fire clearance for six (06) non-ambulatory residents. The facility is currently operating as an independent living home with five (05) tenants who perform all activities of daily living independently and do not require any assistance. The bathrooms contain soap, paper towels, trash can with a lid, and non-skid mats in the shower. The water temperature in bathrooms measured to be 115 &120.3 degrees Fahrenheit. LPA observed a supply of perishable and non-perishable foods in the kitchen. Appliances observed to be in good condition.

The medication to be stored and locked in kitchen cabinets near refrigerator. Laundry area is located at side of the kitchen. Laundry appliances were observed to be in good repair.Toxin observed to be locked and locked under kitchen sink. Sharps locked in kitchen cabinet. Fire extinguisher mounted to kitchen wall observed to be charged. The smoke and carbon monoxide detectors tested to be operational at 11:55 am.

No immediate health or safety hazards were observed; however, a case management visit will need to be conducted before any residents are accepted due to home operating as an independent home with temporary relocation of furniture and other items within the home.

Exit interview conducted. Copy of report provided .