Facility Evaluation Report

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with House Manager Suzanne Evans. According to the facility’s license, the facility has a maximum capacity of four clients, all whom must be 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. Client 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 client activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to client. Medications were labeled, as required, and stored in locked areas.

Pool is appropriately fenced. Per Suzanne, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible.

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

No deficiencies were cited on todays visit.

An exit interview was conducted with House Manager Suzanne Evans, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.