Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff. Mary Grace Aznar, Administrator, arrived shortly after and met with LPA and LPA explained the nature of the visit. Facility is licensed for six non-ambulatory clients. There is one client present during today's visit. Mary Aznar has an administrator certificate valid until 10/01/2025. Upon entry, facility appears clean, safe and sanitary.

LPA Lyman along with Administrator Aznar toured the facility at 8:49 AM. LPA toured the physical plant, checked food service, and reviewed facility documentation. The home consists of three client bedrooms, one shared bathroom, two staff rooms, one staff bathroom, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Auditory exit alarms are operational during today's visit. Client bathrooms were checked. Toilets and water faucets worked properly, and shower was free of mold/mildew. Water temperature measured at 106.5 degrees F in facility bathroom. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for clients. Exit gates are unlocked, self latching and operational. LPA observed a chicken coop in the backyard. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. plan is thorough and complete. Facility provided documentation of last fire drill conducted on 09/01/2024 and drills are conducted monthly. Facility provides activities in the form of games and exercise. At 9:30 AM, LPA reviewed six client files and three staff files. Client files contained required documents including admission agreements, physician reports and individual program plans. Staff files reviewed contained required documentation of training and all pertinent paperwork. CONTINUED ON LIC 809C DATED 09/24/2024