Facility Evaluation Report

Licensing Program Analyst (LPA)'s S. Hurt and S.Doucette arrived at the facility unannounced to conduct an Required Annual Inspection. LPA's were granted entry by Licensee Emmanuel Inneh. LPA's explained the purpose of todays visit.

LPA's reviewed records for 3 facility clients, and 3 facility staff.

LPA's confirmed all staff present is background cleared. Resident 1 does not have complete Admission agreement in file. Staff 1 does not have required Health Screening Report (LIC 503) in file. LPA's observed water temperature in facility resident bathroom located in hallway measured at 100 degrees. The Licensee could not provide current/updated resident roster. LPA's observed facility Resident 2's PRN medications were not correctly documented.

Exit interview conducted with Emmanuel Inneh, and a copy of this report provided, along with appeals rights provided.