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 five non-ambulatory residents, one of which may be bedridden. As of today, the facility has four residents admitted to the facility. All four residents were present during the visit. There’s a total of 3 bedrooms and two bathrooms. 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, shower, and grab bars. Hot water measured in between 106.1 – 118 degrees F. Kitchen: 4 of 4 burners were operational on the gas stove. Sharps are kept locked in a cabinet below the sink. Chemicals are locked in the cabinet next to the sharps directly below the sink. 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 the living room area, in locked cabinets.

File Review: 3 of 4 resident files were reviewed during the visit, and three staff files were reviewed.

Medications/First-Aid Kit: Resident medications are stored in a locked medication cabinet that is stored in the dining room area.

Medication Review: 3 of 4 resident medications were reviewed during the visit.