Facility Evaluation Report

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Slavisa Milosevic. During the visit Licensee Belita Crye arrived at the facility. The facility's license shows a maximum capacity of four (4) ambulatory residents. During today’s inspection there were 3 residents in care.

LPA and Licensee 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. Facility contained 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. No toxic chemicals/poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 24 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Technical advisories were given due to the absence of forms LIC610D and Resident Roster forms.

LPA interviewed staff and clients, and reviewed staff and client records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas.

No deficiencies were cited during the inspection. An exit interview was conducted with Licensee Belita Crye, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.