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 ambulatory clients. As of today, the facility has six clients admitted to the facility. Five clients were present at the beginning of the visit, one client was at day program, and four others left shortly after the visit started. One client remained in their room (Room #5) the entire inspection, and it is unclear if the client has a day program or not. There’s a total of 6 bedrooms and all are for clients. There are two restrooms, 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. Kitchen: 4 of 4 burners and the warmer were operational on the gas stove. Sharps are kept locked in a cabinet below the counter next to the chemicals stored in a locked cabinet directly under the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed in the kitchen.

Client & Staff Files : Client and staff files stored in the office area in a locked filing cabinet.

File Review: 3 of 6 client files were reviewed during the visit, and 3 staff files were reviewed.

Medications/First-Aid Kit: Client medications are stored in a locked filing cabinet in the office area.

Medication Review: 3 of 6 client medications were reviewed during the visit.