Facility Evaluation Report

On 9/24/2021 Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a required 1-year Annual inspection. LPA COVID screened upon entry to the facility. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. Today's census is 4. LPA observed four of four staff observed on site with criminal record clearance in Licensing Information System. LPA observed Licensee's Administrator Certificate expires on 1/3/2023 and Administrator's Administrator Certificate expires on 5/25/2022.

LPA interacted with a random number of residents during this visit and observed residents. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed kitchen, laundry room, restrooms, bedrooms, and common living areas to be in good repair. LPA observed items stored not in use in shed and side yard including wheelchairs and client equipment. The temperature inside the facility was measured at 76*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 at 84*F in restroom and 96*F in kitchen not within regulatory range which is not less than 105*F and not more than 120*F. LPA observed the centrally stored medications, toxins, and knives to be locked inaccessible to residents. 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 fire extinguisher last inspected on 6/15/2021, pull alarm system, smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed COVID precautions signs posted, restrooms stocked with paper towels, hand soap and touchless covered trash can and 30 day supply of PPE stored.