Facility Evaluation Report

On 9/1/2021 Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a Required 1-year Annual Inspection at 9:15am and met with Staff Designee (S1). Administrator and Licensee were not able to be on site during today's inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 15 clients, today's census 10, and accompanied by S1 throughout today's inspection. Two of two staff observed on site with criminal record clearance and associated in Licensing Information System. Person 1 (P1) observed residing in the facility in staff room with criminal record clearance. LPA contacted Regional Office and staff associated P1 to the facility on today's date. LPA observed Administrator Certificate expires on 2/17/2022.

LPA interacted with a random number of clients during this visit. The physical plant was toured inside and outside to ensure the safety of the clients. LPA observed kitchen, laundry rooms, restrooms, bedrooms, and common living areas and backyard, LPA observed items stored not in use or good repair in backyard including a ladder, bed, boxes, backdoor screen torn, tomato cages, wood post, uncoiled hose, and broken pots. Observed one of four exterior structurse not in good repair with cigarette butts inside, S1 stated Resident one (R1) uses in it the winter to smoke inside. LPA observed medications, toxins, and knives stored locked in accessible to clients. LPA observed the pool gates locked and in accessible to clients. The temperature inside the facility was measured at 74*F which is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 111.2*F within regulatory range of not less than 105*F and not more than 120*F. LPA observed newly installed hot water dispenser at kitchen sink in staff area kitchen measured at 140.8*F. The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days maintained on site.