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25 | Licensing Program Analyst (LPA) David Roman conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee, Agnieszka Norton. According to the facility’s license, the facility has a maximum capacity of 12 clients, of whom 10 may be non-ambulatory and hospice waiver for 10.
LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. LPA informed Licensee of 1 wall puncture observed behind a recliner, cables exposed along door passage way. Licensee, reported that the maintenance will work on covering wall and cables. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.
Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 115 degrees F.
LPA observed 1 pool/body of water on the premises surrounded by a 6ft fence and locked. Per Licensee, Agnieszka Norton no firearms or ammunition are kept at the facility. Smoke/carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present. First aid kits were complete and readily accessible. Resident records reviewed had required documentation. Staff records reviewed contained required documentation, CPR/First Aid certificates are up to date.
An exit interview was conducted with Licensee, Agnieszka Norton to whom a copy of this report and the Licensee/Appeal Rights were provided during the visit.
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