Facility Evaluation Report

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit.

Residential home with two levels and licensed for four ambulatory clients. Three clients are currently admitted to the facility. One client was present before leaving for a doctor’s appointment. The other two clients were at their day program during the visit. There’s a total of 4 bedrooms and 2 bathrooms for the clients. There’s a living room space, a dining space, backyard area, and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. No chemicals observed in the bathroom. Hot water temperature measured in the range of 111.7 – 114.3 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked in a cabinet across from the stove. No cleaning chemicals are stored in the kitchen. All cleaning supplies are stored in a locked closet area near the front door. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed in the kitchen and pantry closet near the entrance. Emergency food, water, and disaster bags were also observed in the pantry closet area near the front door.

Client & Staff Files : Client and staff files stored in a locked closet in the main hallway.

File Review: 3 of 3 client files were reviewed during the visit, and three staff files were reviewed.