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 clients, one of which one may be non-ambulatory. As of today, the facility has three clients, and one client was 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 106.5 – 106.7 degrees F. Kitchen: 4 of 4 burners were operational on the electric stove. Sharps are kept locked below the stove. No cleaning chemicals are stored in the kitchen. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed in the kitchen. 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 the locked medication cabinet near the dining room.

File Review: 3 of 3 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 cabinet. Three first aid kits were observed in the medication cabinet.

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