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 residents. As of today, the facility has three residents admitted to the facility. All three residents were present during the visit. There’s a total of 4 bedrooms of and 2 restrooms available. There’s a living room space, a dining space, backyard area 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 106.1 – 106.8 degrees F. Kitchen: 4 of 4 burners and the warmer were operational on the gas stove. Sharps are kept locked in a cabinet near the stove. Cleaning chemicals are stored in a locked cabinet directly below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed in the kitchen area and pantry areas.

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

File Review: All three resident files and three staff files were reviewed during the inspection.

Medications/First-Aid Kit: Client medications are stored in locked medication closet near the front door. A first aid kit with all the required elements was observed in the locked medication cabinet.

Medication Review: 3 of 3 resident medications were reviewed during the visit. Medication is being administered as prescribed, no discrepancies were noted.