Facility Evaluation Report

Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Lori Cook was notified by telephone and arrived later to assist with the visit.

The facility is an Adult Residential Facility licensed for six ambulatory clients. There are currently two clients in care, one of which is present throughout the visit while the second client was observed returning from day program during the visit. The facility is a one-story home with three bedrooms assigned to clients, one of which is vacant. Clients shared one common bathroom. There are two additional staff rooms. Facility's interior appears clean, safe, and sanitary. All clients’ rooms had required elements, including bed, chair, closet space, and ample lighting. Facility has extra linens and hygiene supplies for all two clients. Hot water measured at 150 degrees Fahrenheit in the bathroom used by clients, type A citation issued. LPA observed the facility had a two-day supply of perishables and a seven-day supply of non-perishable food as required by regulations. LPA observed hallways and walkways were free of obstruction. There are no bodies of water on the premises

LPA observed the fire extinguisher mounted on the dining room wall is charged and has a maintenance tag dated 2024. Staff and LPA tested smoke and carbon monoxide detectors which were found to be operational. Cleaning products and sharp instruments are stored in a locked cabinet in the kitchen. Medication for each client is kept locked and secured in a locked medication cart in the dining room. The backyard has one shaded seating area, and the exit gate is unlocked and unobstructed.

LPA reviewed two clients’ files and medications as well as P&I records which were verified to correspond to the amount noted on the ledgers. LPA reviewed three staff files. All files of staff and clients contained all required documentation. All current staff members and individual residing on the premises are cleared and associated. CONTINUED ON FORM LIC809-C