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, one of which may be non-ambulatory. As of today, the facility has four clients, and all were present during the annual inspection. There’s a total of 4 bedrooms for the clients and two restrooms. 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 109 – 110.8 degrees F. Kitchen: 4 of 4 burners were operational on the gas stove. Sharps are kept locked below the sink. Cleaning chemicals are stored below the sink on the opposite side of the sharps. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. An additional supply of perishable food items was observed in the refrigerator in the garage.

Client & Staff Files : Client and staff files are located in a locked cabinets in the garage.

File Review: 3 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 closet near bedroom #3.

Medication Review: 3 of 4 client medications were reviewed during the visit.