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, one of which may be bedridden. The facility currently has six residents admitted and all were present during the visit. There are a total of five bedrooms and two restrooms available. I bedroom is currently vacant. 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 was measured at 119.3 degrees F. Kitchen: 4 of 4 burners and the warmer is operational on the gas stove. Sharps are kept locked cabinet near the sink. Cleaning solutions are stored in a locked cabinet below the sink. 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 across from the dining table.

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

Medications/First-Aid Kit: Resident medications are stored in a locked medication cabinet in the kitchen.

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