Facility Evaluation Report

Licensing Program Analyst, Amber Coleman (LPA) arrived at the Member's MVP Adult Facility to conduct an Annual Inspection. LPA was greeted by Administrator, Nikki Von Jena at the door. LPA introduced self and stated purpose of the visit. LPA was granted entry and asked to sanitize and sign in. LPA was informed the current census is 4, but all residents were attending their prospective Day Programs at time of visit.

LPA's visit consisted of a walk through of the facility, staff interview and review of files.

Personnel Records/Training/and Staffing- LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. Records observed to be complete and adequate.

Resident Records/Incident Reports/Personal Rights/Residents with Special Needs/Incidental Medial and Dental- LPA began review of resident records. Four (4) records were reviewed. LPA reviewed for admission agreement, medical assessments and TB test results, consent forms, identification and emergency information documents, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification.

Resident rooms - all included required furniture, observed in good repair. Rooms clean and orderly. Adequate storage space and access to clean linens and hygiene products. Bathrooms observed to included appropriate hand soap, and paper towels.

Food Service- Staff observed preparing a meal for residents upon their arrival home. LPA observed a secure drawer for sharp objects. LPA also observed secure cabinets for cleaning solutions. Food prep areas are cleanly and orderly. Food supply meets the requirements of regulations- (1) week supply of nonperishable and two (2) day supply of perishables food on hand. Emergency rations were observed in the garage along with emergency supplies for facility.