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 non-ambulatory clients, 1 of which may be bedridden. As of today, the facility has one client admitted to the facility. There is a total of five bedrooms and two bathroom areas. One bedroom is being used as a staff office area. 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. No chemicals observed in the bathroom. Kitchen: 4 of 4 burners are operational on the gas stove. Sharps are kept locked in a cabinet as well as the chemicals and a supply of hygiene items. 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 the staff office in a locked cabinet.

File Review: 1 of 1 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. The first aid kit is also locked in the a kitchen cabinet near the medication cabinet.

Medication Review: 1 of 1 client medications were reviewed during the visit.