Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Kokumo and explained the purpose of the visit.

This is a MH home. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture, however the lighting throughout the facility needs addressing by replacing bulbs were they are needed. During the tour LPA observed overgrown shrubbery in backyard, dirty refrigerator and broken cabinet in the resident bathroom, dirty carpet and walls. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 112.5 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees.

Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 3 resident and 1 staff files, including criminal record clearances. During the file review LPA observed that S1 does not have a health screening as required. Fire drill was completed. The facility has no infection control plan on file.

All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete. Deficiencies were cited. The facility is receiving Technical support for it other facility with similar compliance issues. LPA will refer this facility to Technical Support for assistance with compliance.