Facility Evaluation Report

On 01/26/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced annual inspection

with emphasis on infection control. LPA was met by Direct Support Staff Tina Bell, and the purpose of

LPA and Staff toured the facility which has 2 single-story buildings, on the same lot, with address numbers 1071-1073 The first building (1071) consists of 3 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. The second building (1073) consists of 2 Client bedrooms, 1 Live-in Staff bedroom, 2 bathrooms, living room, dining room, kitchen, and attached garage.

All outdoor and indoor passageways were free of obstruction. Each client's room has clean linens, a lamp, a chest of drawers, and closet space. The bathrooms were clean and free of mold/mildew. Client rooms are equipped with a wired smoke detector and is operational. There is one working carbon monoxide detector in the living room for each building.

LPA observed a minimum of two days perishable and a week of nonperishable foods maintained at the facility.

LPA reviewed 4 Client files, and 4 Staff files, and 1 Medication Record. The client files reviewed have the following documentation: Admission Agreement, Identification and Emergency Information, Consent forms, Physician's Report that includes the T.B. test results. Their Needs and Services Plans are updated as necessary. All medications were up to date, and were centrally stored and locked, making it inaccessible to clients.