Facility Evaluation Report

On 9/20/2021 Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a Required 1-year Annual Inspection at 10:15 with Designated Staff One (S1). LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 clients and today's census is 6. S1 accompanied LPA on facility tour. Licensee arrived shortly there after. Five of Five staff observed on site with criminal record clearance in Licensing Information System. LPA observed Administrator Certificate expires on 11/29/2022. Prior to today's visit LPA contacted Licensee for COVID screening who confirmed no staff or clients have shown symptoms or tested positive in the past ten days.

LPA interacted with a random number of clients during this visit and observed clients. The physical plant was toured inside and outside to ensure the safety of the clients. LPA observed kitchen, garage, restroom, bedrooms, and common living areas to be clean and in good repair. LPA observed items stored including roof repair item from next door facility, Staff two (S2) immediately moved item to dumpster. LPA observed toxins, knives, centrally store medications stored inaccessible to clients. The temperature inside the facility was measured at 72*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 102*F not within regulatory range of is not less than 105*F and not more than 120*F. S1 immediately contacted Staff three (S3) to adjust the water heater who found it was turned to cold. Staff four (S4) stated they completed showers of 6 clients prior to LPA's entry. LPA remeasured hot water to be at 105*F at the end of the visit.

The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, but containing sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution.

Facility handles P & I monies, LPA observed the log is maintained correctly and there is no commingling of funds. LPA observed the facility conducts fire drills documented monthly.