Facility Evaluation Report

At 10:40 a.m. on 12/08/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and disclosed the reason for the visit. LPA later met with the administrator designee and toured the facility inside and out at 1:00 p.m. No immediate health and safety hazards were observed during this visit.

The facility was last visited on 05/04/2022 for a case management visit. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 5 nonambulatory clients. Bedroom #1 is approved for 2 nonambulatory clients and Bedrooms #2, #3, and #4 are approved for 1 nonambulatory clients.

At 11:30 a.m. LPA conducted a file review. During today;s file review, it was discovered that five (05) out of five (05) staff did not have LIC 501, LIC 503, or LIC 9052 forms available for audit. A type B deficiency is cited on the attached LIC 809-D page.

At the main entrance, LPA observed a maintained front yard and a wheelchair lift in good condition. Postings observed inside the main entrance were the facility’s license, facility sketch with evacuation routes clearly labeled, client list, personal rights, grievance policy, emergency disaster plan, confidential complaint contacts, and COVID precautions.

All emergency exit paths were free from obstructions. Exit gates were unlocked with self-closing latches. At approximately 1:20 p.m., two (02) out of two (02) dual-functioning smoke and carbon monoxide detectors were tested and operational. At approximately 1:30 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 12/21/2022. The facility uses surveillance cameras on the exterior.

At 1:25 p.m. LPA and Designee determined the facility vehicle to be operational and safe.