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 ambulatory clients. As of today, three clients are admitted to the facility. There’s a total of 4 bedrooms, 3 of which are for clients and one bedroom is for staff. There are two restrooms, one for clients and one for staff. 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, sink, and tub/shower. Hot water measured at 108.8 degrees F. Kitchen: 4 of 4 burners were operational on the gas stove. Sharps are kept locked in the medication cabinet in the main hallway. No cleaning chemicals are stored in the kitchen. 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: 3 of 3 client files were reviewed during the visit, and 2 staff files were reviewed.