Facility Evaluation Report

Licensing Program Analysts (LPAs) Tiffany Holmes and Eryn Kane conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were greeted and allowed entry into the facility by Direct Support Professional (DSP) Nicholas Spatz to whom LPAs discussed the purpose of the visit. House Manager Kevin Jones was present at facility. According to the facility’s license, the facility has a maximum capacity of six (6) ambulatory clients. During today’s inspection, Five (5) clients were present and then left for day programs.

LPAs, accompanied by House Manager Jones, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant at 68 F. Hot water temperature at taps accessible to clients were 130-131.9. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, the open-faced heaters was accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per House Manager Jones no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers (2) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Deficiencies were observed and cited during today's annual inspection.

An exit interview was conducted with House Manager Jones, to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.