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, one client was out with family and one client was still at day program at the beginning of the visit. There’s a total of 4 bedrooms and 2 restrooms for the clients. 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. No chemicals observed in the bathroom. Hot water was measured at 105 degrees F. Kitchen: 4 of 4 burners and the warmer were operational on the gas stove. A perishable and non-perishable food supply was observed. Sharps are kept locked in a cabinet and chemicals are kept locked directly below the sink. Food Service: A supply of perishable food items was observed in the refrigerator, and a non-perishable food supply was observed in the kitchen cabinet.

Client & Staff Files : Client and staff files stored in a filing cabinet in an open area next to the laundry room.

File Review: 3 of 4 client files were reviewed during the visit, and 3 staff files were reviewed.