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, the facility has four clients admitted to the facility. Two clients were present during the visit, and two other clients were at their day program. There’s a total of 4 bedrooms and all four rooms are for the clients, and two client restrooms available. There’s a living room space, a dining spaces, a 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 was measured in the range of 114.4 degrees F. Kitchen: Clean and well organized. Sharps are kept locked in a cabinet. 4 of 4 burners were operation on the gas stove. No chemicals are stored in the kitchen. Food Service: A supply of perishable food items was observed in the refrigerator, and a well-organized non-perishable food supply was observed in the kitchen cabinet.

Client & Staff Files : Client and staff files are stored in the locked filing cabinet in the living room area near the front door. File Review: 3 of 4 client files were reviewed during the visit, and 3 staff files were reviewed.

Medications/First-Aid Kit: Client medications and the first aid kit are stored in a locked medication closet near the front door. Disaster bags for the clients and a first aid kit with all the required elements are in the locked medication closet. Medication Review: 3 of 4 client medications were reviewed during the visit. No discrepancies were observed, medication is being administered as prescribed.