Facility Evaluation Report

Licensing Program Analyst (LPA) Angel Ascencio conducted a required annual inspection to the above facility. The LPA met with Administrator Mary Ann Howe at 09:40 a.m. Entrance interview conducted.

The LPA and Administrator Howe toured the physical plant areas inside and outside with the applicant to ensure there are no health and safety hazards.

BEDROOMS: All resident rooms are set up with beds, night stands, lamps, chests of drawers,

chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean

linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a

bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for

easy passage between the beds. In addition, no bedroom was used as a passageway to another

room, bath or toilet. There are five (5) total rooms - one (1) is a staff room, two (2) are shared, and 2 are private.

RESTROOMS : There are three (3) bathrooms for resident use; the full bathroom in the hallway is designated for staff and guests. Resident bedroom #1 and #5 have an attached bathroom that is shared between bedroom #1 and bedroom #5. Resident bedroom #3 has an attached bathroom for private use. During the visit, the LPA observed signs in all of the bathrooms pertaining to proper hand hygiene. All cleaning supplies were inaccessible to client in care. In addition, restroom hot water measured under 120.0 degree F.

KITCHEN: Kitchen knives are stored in a locked closet by the kitchen. The supply of dishes, utensils, pots,

pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the