Facility Evaluation Report

Unannounced annual visit made out to this facility on 10/06/2021 by this LPA who was met by the facility designated Administrator, Bokime Etim, who was briefly interviewed at this time.

Current census was 2 residents, of which (1), was out of the facility for their day program at this time.

This facility is licensed to serve and accept up to 6 residents who are deemed to be ambulatory and non ambulatory as well. This facility is vendorized to accept and retain Level 4I residents at any given time.

Dining area, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

Kitchen area was toured. Cabinets and storage units for cook ware and kitchen ware were observed to be sufficient and able to meet the needs of the residents at this time.

Food storage units, facility refrigerator unit and freezer unit, were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Pantry area housing dry goods and products was toured. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures were discussed with the facility designated Administrator in regards to dispensing, documenting, and communication for all involved parties.

First aid kits were observed to be present and contained all of the required components at this time.

Fire extinguishers were observed to have been annually inspected on 06/07/2021 by the local fire equipment company and found to be in compliance at this time.

A tour of the resident bedrooms was conducted. Bedroom furniture and furnishings were observed to be sufficient and in compliance at this time.

A tour of the resident restrooms was conducted. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees.

Garage area was toured. Additional food storage unit was observed to be in use for 2-day perishable food supplies.

Emergency food and packs were observed to be used and prepared in the garage area.