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, Patricia M White. According to the facility’s license, the facility has a maximum capacity of six clients, of whom none are non-ambulatory and none bedridden.

LPA toured the interior and exterior of the facility and inspected each of the 5 bedrooms and 4 bathrooms. 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. Residents currently do not take medications however, if needed would be locked. LPA observed one pool, one hot tub on the premises. The pool has a 5 ft fence around it and the hot tub is covered and locked. Per Patricia M. White, no firearms or ammunition are kept at the facility. Smoke/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. Resident and staff records reviewed had required documentation.

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