Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 9:06 a.m. to conduct a 1-year annual visit to the facility above. LPA met with Valentina Roberts and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The facility is a 4 bedroom and 2 bathrooms, with one staff room in the garage. The facility occupies 3 residents and employs 5 full-time staff of which one is the Administrator and one is a back-up administrator. Facility has 3 relief staff if needed. The facility is clean, safe and sanitary. The facility has smoke and carbon monoxide detectors which were tested and working properly at time of inspection. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. The facility has telephone and internet service for residents’ use.

Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 09/21/26. The facility is approved for a capacity of 6 bedridden and approved for hospice waiver of 4.

Staffing, Personnel Records & Training: LPA reviewed 3 staff files. Files were reviewed for, but not limited to current 1st Aid/CPR, Personnel Records/Application, and Health screening with TB results. Continued 809-C