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 residents, As of today, the facility has three residents admitted. All residents were present upon LPA’s arrival and then left for their day program. There’s a total of 6 bedrooms of which 4 bedrooms are for the residents and two bedrooms have been converted into activity areas. There are two restrooms available. 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 measured in between 116.2 – 116.6 degrees F. Kitchen: All burners and the warmer were operational on the gas stove. Sharps are kept locked cabinet near the stove. Dish soaps and cleaning chemicals are stored below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed.

Resident & Staff Files : Resident and staff files stored in the main office.

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

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

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