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, one of which may be bedridden. As of today, the facility has zero residents admitted to the facility, and has not had any residents admitted to the facility since being licensed. There’s a total of three bedrooms and two bathrooms. There’s a living room space, a dining space, backyard, and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. No chemicals observed in the bathroom. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked in a cabinet near the sink. Cleaning chemicals are stored in a cabinet directly below the sink. Food Service: The facility is currently empty. LPA did observed a supply of nonperishable food items in the kitchen the Licensee/Administrator says is a part of the emergency food supply.

Resident & Staff Files : Resident and staff files stored in the locked closet next to the front door.

Medications/First-Aid Kit: Client medications will be stored in the locked room (former laundry room) inside a locked cabinet.