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 residents, of which six may be non-ambulatory, and a hospice waiver for two. As of today, there are five residents admitted to the facility. There are six bedrooms (5 resident & 1 staff) and two restrooms available. There’s a living room space, a dining space and a detached 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 110.2 – 116.2 degrees F. Kitchen: Sharps are kept locked cabinet under the sink. Cleaning chemicals are in a locked cabinet in the main hallway. 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 kitchen.

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

Medications/First-Aid Kit: Resident medications are stored locked medication cabinet in the kitchen. A first aid cabinet with first aid supplies and first aid manual was observed.

Medication Review: 3 of 5 resident medications were reviewed during the visit. No discrepancies were noted. Medication are being administered as prescribed.