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 residents. As of today, the facility has six residents admitted to the facility. All six residents were present during the inspection. There’s a total of 5 bedrooms, of which 4 bedrooms are for the residents, and one bedroom is for staff. There are two restrooms available. There’s a living room space, a dining space, backyard, 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. Grab bars are tightly secured to the wall. No chemicals observed in the bathroom. Hot water measured in the range of 108.6 – 109.5 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked drawer near the sink. Cleaning solutions are stored in a locked cabinet directly below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed.

Resident & Staff Files : Resident and staff files stored in a locked cabinet area behind the dining table.

File Review: 3 of 6 resident files were reviewed during the visit, and three staff files were reviewed. No discrepancies were noted.

Medications/First-Aid Kit: Resident medications are stored in a locked medication cabinet in the dining area. A first aid kit with a manual was observed in the garage.