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, one of which may be bedridden. As of today, the facility has five residents admitted to the facility. Four residents were present during the visit. There’s a total of 4 bedrooms, 3 of which are for residents. One bedroom is being used as an office space. There are two restrooms, one for residents and one for staff. The staff restroom is locked, but can be used by 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, sink, and tub/shower. Grab bars are tightly secured to the wall. Hot water measured at 113.7 degrees F. Kitchen: 4 of 4 burners were operational on the gas stove. Sharps are kept locked in the medication cabinet next to the refrigerator. Cleaning solutions are stored in a locked cabinet below the sink. 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 a locked cabinet in the staff office room.

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

of 5 resident medications were reviewed during the visit.