Facility Evaluation Report

Licensing Program Analyst, LPA Noel Wolf Petersen, arrived unannounced to the facility to conduct a annual inspection. LPA Met with licensee/administrator Joan Little and Licensee Doug Little to explain the purpose of the visit. Empire guest home is a 22 bed 4 bath, adult residential facility taking clients between 18-59.

Phyical inspection was completed, including the kitchen, bedrooms, bathrooms, exterior, and evacuation route gate. the facility is clean, the traffic areas are clean and unobstructed.

Kitchen has adequte storage space for sharps, toxics, and medications. there are 2 days perishable food and 7 days non perishable food. The employee with thier primary responsibility as designated to handle meal prep, menu planning, etc is Mark "Doug" Little.

Bedrooms- bedrooms have adequate hardware and furnishings. LPA gave guidance to check the facility beds for plastic/rubber matteress encasements.

Bathrooms: adequate hardware is 10 persons per bath, and 6 persons per toilet and wash basin. ratios are a little tight with regard to toilets. a porta potty exists in the back lot, unclear if used. one bathroom has a hair washing station.

Common/exterior areas have plenty of space for activities.

Evacuation route- no gate, the front and side doors open to a largely empty lot used for storage and volleyball. no obstruction to the road. Continued on C page.