Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit and was greeted by the caregiver. The Administrator arrived at 1:00 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 Administrator began the tour of the facility at 1:10 pm until 1:25 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, residents' files, and residents' medications were locked in a cabinet in the dining room. The dining area contained a dining room table and chairs The water temperature was tested at 1:30 pm and the temperature was 120.0 F.

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

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

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

Garage - LPA observed the cleaning solutions, PPE, and emergency water.