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 four clients, of which two may be nonambulatory. As of today, the facility has four clients admitted to the facility. One client was present during the inspection and the other clients were at their day program. There’s a total of 5 bedrooms: four for the clients and one for staff, and two restrooms. There’s a living room space, a dining space, a laundry room, staff office, and a detached 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 was measured in the range of 106.1 – 110.3 degrees F. Kitchen: Clean and very well organized. Sharps are kept locked in a cabinet below the countertop, and chemicals are stored in a cabinet directly below the sink. Client medications are also stored in a locked cabinet below the countertop. Food Service: A supply of perishable food items was observed in the refrigerator, and a well organized non-perishable food supply was observed in the kitchen cabinet.

Client & Staff Files : Client and staff files stored in the locked office.

File Review: 3 of 4 client files were reviewed during the visit, and 2 staff files were reviewed.

Medications/First-Aid Kit: Client medications are stored in a locked cabinet in the kitchen.

Medication Review: 3 of 4 client medications were reviewed during the visit. No discrepancies were noted.