Facility Evaluation Report

Licensing Program Analyst, Amber Coleman (LPA) arrived at the Peyton's Place Harvard Adult Residential Facility unannounced to conduct an Annual Inspection. LPA was greeted at the door, by staff member Martin Jiminez, (S1). LPA introduced self and stated the purpose of the visit. LPA was granted entry and agreed to sign in and have temperature taken. S1 contacted facility Administrator Christopher Warner who later arrived during the visit. LPA was informed that the current census is 3. Two resident were at their prospective day programs. There are currently no suspicions of anyone in the facility to have COVID19. LPA's visit included a walk through of facility, review of records and staff interviews.

Personnel Records/Training/and Staffing- LPA began review of employee records. 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. All records were observed to be complete.

Resident Records/Incident Reports/Personal Rights/Residents with Special Needs/Incidental Medial and Dental- LPA began review of resident records. Three (3) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. All information was observed in the files to be complete.

Food Service- LPA was present after breakfast. Staff was observed cleaning the kitchen. Sharp objects are kept in the facility's secured laundry room, in a cabinet. LPA observed a container with sharps. LPA also observed cleaning chemicals and laundry detergent to be kept there too. LPA observed a monthly menu posted on the kitchen counter top. The meals are adequate to meet the nutritional needs of the residents. Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables food on hand.

Administrator informed LPA fire drills are conducted every 3 months. Last fire drill 1/7/23. Last earthquake drill 11/15/22. Fire extinguishers observed fully charged, last inspected Jan. 2023.

No deficiencies observed during the inspection. CARE Tool utilized. An exit interview was conducted where this report was reviewed and discussed.