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, of which one may be bedridden. As of today, the facility has five residents admitted to the facility. All of the residents were present during at the beginning of the visit, before one left for day program. There’s a total of 5 bedrooms (3 resident & 2 Staff) and 2 bathroom (1 resident & 1 staff) areas for residents. There’s a living room space, a dining space, backyard 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 was measured at 106.8 degrees F. Kitchen: 4 of 4 burners are operational on the gas stove. Sharps are kept locked under the sink. Cleaning chemicals are stored in a locked cabinet above the washer. A dryer is located in the kitchen across from the washer. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed.

Client & Staff Files : Resident and staff files are stored in the locked closet near the entrance of the facility.

File Review: 4 of 5 resident files were reviewed during the visit, and 3 staff files were reviewed.

Medications/First-Aid Kit: Resident medications are stored in the locked medication closet. A first aid kit was also observed.

Medication Review: 3 of 5 resident medications were reviewed during the visit.