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; of which, one may be bedridden. As of today, the facility has five residents admitted to the facility. All of the residents were present during the visit, all residents were observed in their room during the visit, except one resident who was observed watching television. There’s a total of 6 bedrooms and 4 bathroom areas. There’s a living room space, a dining space and a detached 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 105.2 – 106.5 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked in the a kitchen drawer. Cleaning chemicals are stored below the sink in a locked cabinet. 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 locked filing cabinets near a dining table below the facility postings board.

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

Medications/First-Aid Kit: Resident medications and the first aid kit are stored in the locked filing cabinets near the dining table.

Medication Review: 3 of 5 resident medications were reviewed during the visit. Discrepancies were noted and photos were taken.