Facility Evaluation Report

Licensing Program Analyst, LPA, Noel Wolf Petersen and Licensing Program Manager, LPM, Liza King arrived unannounced to the facility at 5:15am to conduct a annual inspection. The LPA and LPM met with the administrator, Tor Rendentor and explained the purpose of the visit. facility has 6 capacity, five in the current census, and no restricted condtions, eveybody is ambulatory.

Physical Plant was inspected, including the bedrooms, bathrooms, kitchen, common areas, storage areas, exterior, and the evacuation route gate. facility is clean, traffic areas are well lit and unobstructed.

Bedrooms have required furniture and furnishings, including mattress encasements.

Bathrooms have functional hardware, the water temperature is measured at 120*F.

Kitchen has adequate lockable storage for sharps and toxics and medication, there is some rice in the rice cooker from the day before. 2 days of perishable food, 7 days of non perishable food is adequate for 5 clients. Some freezer burned foods, a moldy cheese that was asked to be thrown away. unmarked leftovers should be dated once Opened/stored. LPM asked to label the foods immediately.

Common areas and exterior have furniture in good repair, space for activities, and are free of trip hazards.

The evacuation route gate swings freely and latches closed.

The smoke alarm is functional, fire extinguishers are past due Admin went and recharged during visit.

First aid kit had all components. Evacuation binder exists.