Facility Evaluation Report

Licensing Program Analyst (LPA) David Roman conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator, Tamara Royer. According to the facility’s license, the facility has a maximum capacity of 4 clients, of whom all are ambulatory.

LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. No Medications were labeled, as the client is not required to take medication. However, Licensee has a medication lock box in the kitchen cupboard. Water temperature was measured at 105 degrees F.

1 body of water on the premises is a jacuzzi that is covered and locked. Per Licensee, no firearms or ammunition are kept at the facility. Smoke/Carbon monoxide detectors tested at 1:05PM emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible.

Resident records reviewed had required documentation. Staff records reviewed contained required documentation.

An exit interview was conducted with Licensee, Tamara Royer, to whom a copy of this report and the Licensee/Appeal Rights were provided during the visit.