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. There’s a total of 6 bedrooms of which, four bedrooms are for the clients, one bedroom is for staff, and one bedroom is currently vacant. There are two restrooms available. There’s a living room space, a dining space, a backyard area, and an office. 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 105 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. No sharps or chemicals are stored in the kitchen. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed.

Client & Staff Files : Client and staff files are located in the locked office area in filing cabinet(s).

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 filing cabinet in the locked office. A first aid kits with all the required elements is located in the office in the cabinet with the client files.

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

Linens & Hygiene Supplies: Hygiene caddy’s were observed in clients bedrooms.