Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Maryann Davis and explained the reason for the visit.

Facility is licensed as a Social Rehabilitation Facility to serve 6 ambulatory clients. The facility is a two story home located in a residential area and consist of 3 client bedrooms, 3 bathrooms, a staff bathroom, a kitchen, a living room, an activity room, a laundry room in the basement, a front porch, and a back yard.

LPA conducted a tour of the facility with Maryann Davis and observed the following:

Facility is in good repair indoor and outdoor. Living room and activity area have sufficient seating area and fire places are inaccessible to clients. Kitchen and dining area were observed clean, snacks were observed, cleaning supplies were observed locked. Facility has a Food delivery waiver, meals are prepared in the main house and delivered to the facility. Each client room (3) has the required furniture, sufficient lighting and bedding supplies. Bathrooms (3) were observed clean, in good repair, and water temperature was tested in each bathroom between 109.2-115.3 degrees F., which is within the required 105-120 degrees F. Medication was observed locked in the medication cabinet. Sharps are not accessible to clients. Smoke/Carbon dioxide detectors were observed, tested, and in working condition. No large bodies of water were observed. Front yard has a porch with seating area, and backyard has a shaded seating area provided. Emergency evacuation chair was not observed. Fire extinguishers were observed and last checked on 11/17/23.

LPA reviewed files and medication for 5 clients and 5 staff files. Client #5(C5) does not have a TB test on file. Emergency Disaster plan was reviewed and last reviewed on 2/3/24. Infection control plan was reviewed. Administrator Certificate for Cory Mitchell was observed #6069942735 exp. 11/14/23.

Deficiencies were noted on LIC 809D per Title 22 Regulations.

Exit interview was conducted with Cory Mitchell and a copy of this report, LIC 809D, and appeal rights were provided.