Facility Evaluation Report

Licensing Program Analyst (LPA) Angelica Boyles made an unannounced visit to the facility to conduct the required annual inspection. LPA identified herself to Administrator Basim Alsaeed, explained the purpose of the visit, and was granted entry into the facility. The facility is licensed to serve four (4) clients of whom all four (4) must be ambulatory.

During today’s visit, LPA, accompanied by Administrator toured the interior and exterior of the facility, and inspected each room. LPA observed the facility to be sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was comfortable and compliant and hot water taps accessible to clients measured within compliant range.

LPA observed 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, or open-faced heaters accessible to clients. Medications were stored in labeled containers in a locked room. A first aid kit and manual, fire extinguishers, smoke alarms, and carbon monoxide detectors were present and operable. Staff and client records were complete and up to date.

No deficiencies were observed or cited during today's visit. This report was discussed with Administrator Basim Alsaeed. A copy of the report and Licensee Rights (01/2016) were provided at the conclusion of the visit, and signature on this form acknowledges receipt.