Facility Evaluation Report

At 10:0am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with Rita Dafrique, Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit.

At 10:05am LPA conducted a tour of the physical plant and observed the following:

Facility is an Adult Residential Care Facility which was licensed for capacity of four (4) of which four (4) non-ambulatory and one (1) bedridden client. Facility has an office, four (4) bedrooms designated for residents use, two (2) bathrooms and LPA was informed that the facility has awake staff at night. LPA was able to tour the home and did not observe any immediate health and safety concerns. Smoke detectors and carbon monoxide monitors were observed to be functional. Facility maintains a temperature of 70°F. LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Sharps, cleaning supplies and medications are centrally stored and are kept locked in various kitchen cabinets and drawers. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. The hot water temperature measured at 113.7°F. Extra towels and linens were readily available. The fire extinguisher was observed in the kitchen area and was last serviced on 09/15/2023. Laundry is located in an attached garage, and LPA observed all chemicals and detergents are kept locked and inaccessible to clients. LPA observed a clean covered patio and backyard furniture to accommodate the four (4) clients. Between 11:00am to 12:00pm, LPA reviewed records of four (4) clients and two (2) staff. Resident and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500.

Exit interview conducted and copy of this report signed and delivered.