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 non-ambulatory residents. As of today, the facility has six residents admitted to the facility. All of the residents were present during the visit, except one resident who is currently in a Skilled Nursing Facility (SNF) and is expected to returned once released. There’s a total of 4 bedrooms and 3 bathroom areas for residents. 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 110.4 – 111.5 degrees F. Kitchen: 4 of 4 burners and are operational on the gas stove. Sharps are kept locked in the medication cabinet. Cleaning chemicals are stored below the sink in a locked cabinet. 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 locked office area in a locked filing cabinets.

File Review: 3 of 5 resident files were reviewed during the visit, and 3 staff files were reviewed.

Medications/First-Aid Kit: Resident medications are stored in the kitchen in a locked cabinet. 2 first aid kits were observed in the locked office area.

Medication Review: 3 of 5 resident medications were reviewed during the visit.