Facility Evaluation Report

Licensing Program Analyst (LPA) Chavez conducted an unannounced Annual/Required visit. LPA met with Kerri Smith, House Supervisor, and Tammy Peterson, House Manager, and explained the purpose of the visit. Also, in attendance was Jeff Edler, Tri-Counties Regional Center (TCRC), Quality Assurance Specialist.

LPA toured the facility with the house supervisor and TCRC. Facility is maintained in conformity with state fire marshal regulations. Smoke detectors and carbon monoxide detector functioning properly. Fire extinguishers (3) were located at the inside entranceway, the hall near the garage, and the hall near resident bedrooms. Extinguishers were fully charged and last inspected on 6/15/22. There are no pools or bodies of water at facility. No fire arms or dangerous weapons are located at facility. Hot water temperature measured between 115 F and 119 F degrees in resident bathrooms (3). All toilets and hand washing facilities are maintained in a safe, sanitary, operating condition. The facility is clean, safe, sanitary and in good repair for the safety and well-being of clients, employees, and visitors with the exception of two window screens needing repair at the kitchen and office. Each client is accorded safe, healthful, and comfortable accommodations, furnishings and equipment to meet his/her needs. LPA observed clients being treated with dignity and respect. There is a minimum 2-day supply of perishables and 7-day supply of nonperishable foods. Food is stored and prepared in a safe and healthful manner. Disinfectants, cleaning solutions and poisons are inaccessible to residents. Facility has adequate emergency supplies and first aid supplies. Facility temperature is 74 degrees Fahrenheit. Outdoor walkways are free from obstruction and the facility has outside areas for individuals to use. Centrally stored medication is kept secure in the locked office and inaccessible to clients. Medications are given as prescribed by doctors’ orders. The last emergency disaster drill was conducted on 4/6/23. LPA reviewed (5) staff files for criminal record clearances and associations, Health screening with TB results, and current First Aid/CPR. One out of five staff files reviewed did not have documentation showing results of a negative TB test. Deficiency cited. LPA reviewed (5) client files for current needs and services plans and signed admission agreements and personal rights. All files are in compliance.

Exit interview conducted, deficiency cited, and the report and appeal rights given.