Facility Evaluation Report

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Licensee Victor Schard and explained the purpose of the visit. The facility is licensed to serve three (3) residents of whom all three (3) must be ambulatory. During today's visit all three residents were present.

During today’s visit, LPA Correia, accompanied by Licensee Schard, toured the interior of the facility. LPA observed the interior of the facility to be sanitary and in good repair. LPA observed required postings, the fire extinguisher was current on inspection, and smoke alarms and carbon monoxide detectors were present and operable. The facility was following disaster drills and had current liability insurance. All residents’ bedrooms had the required furnishings, including padded mattress covers. Toilet and shower were in working order and equipped with non-skid flooring and grab bars. The facility’s ambient internal temperature was 74 F. The facility had an adequate supply of clean linens. LPA observed Personal Protective Equipment (PPE) and First Aid Kit and Manual. Medications, sharps, and toxins were housed in locked cabinets and inaccessible to residents in care. Per Licensee Schard there are no weapons or ammunition kept on the facility premises.

LPA also conducted a review of staff and resident records, including P&I and ledger, all were complete, accurate and up to date. No deficiencies were cited during today's visit. This report was discussed with Licensee Schard. A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of the reports.