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, one of which three may be non-ambulatory. As of today, the facility has four residents admitted to the facility. None of the residents were present during the visit. There’s a total of 6 bedrooms of which 4 bedrooms are for the residents and two bedrooms have been converted into activity areas. There are two restrooms available. There’s a living room space, a dining space 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. Hot water measured in between 105 – 106 degrees F. Kitchen: 3 of 4 burners and the warmer were operational on the electric stove. Sharps are kept locked cabinet near the sink. Only dish soap is stored in the kitchen below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed.

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

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

Medications/First-Aid Kit: Resident medications are stored in a medication closet near the front door.

Medication Review: 2 of 4 resident medications were reviewed during the visit.