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.

The facility is a single level structure and licensed for six ambulatory clients. As of today, there are 6 clients admitted to the facility. There’s a total of 4 bedrooms (all for clients), and two restroom areas. One of the bedrooms has been converted into an activity room. There’s a living room space, a dining space, attached garage and backyard space. 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 measured in the range of 108.5 – 114.6 degrees f. Kitchen: All burners are operational on the gas stove. Sharps are kept locked toolbox stored directly below the sink. No cleaning chemicals stored in the kitchen. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed in the kitchen.

Client & Staff Files : Client and staff files stored in locked file cabinets in the dining room.

File Review: 3 of 6 client files were reviewed during the visit, and three staff files were reviewed.

Medications/First-Aid Kit: Client medications are stored in a locked medication cabinet in the dining room. A first aid kit with all the required elements was observed in a kitchen cabinet with N95 mask, and surgical mask.

Medication Review: 3 of 6 client medications were reviewed during the visit. No discrepancies were noted. Medication is being administered as prescribed.