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 clients. As of today, the facility has four clients admitted to the facility. Three clients were at their day program and not present during the inspection. One client was present during the visit. There’s a total of 6 bedrooms, of which 4 bedrooms are for the clients, one bedroom has been converted into activity area, and one bedroom is used as a storage space. There are two restrooms available. There’s a living room space, a dining space, activity room, storage room, 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 measured in the range of 106.1 – 106.5 degrees F. Kitchen: 4 of 4 burners are operational on the gas stove. Sharps are kept locked in a cabinet next the stove. Cleaning solutions are stored in a locked cabinet directly below the sink. Medications are locked in a cabinet above the counter. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed in the kitchen, and the pantry area and in the hallway.

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

File Review: 2 of 4 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 kitchen. A first aid kit with a manual is locked in a main hallway cabinet.

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