ABC _ Health and Safety-2024 Question Title * 1. Today's Date Date Date Question Title * 2. Location SHOULDERS HOUSE ASHER HOUSE Question Title * 3. Reviewer's Name and Title Question Title * 4. Date of Last Fire Extinguisher Inspection Date Date Question Title * 5. Fire Exits Cleared? Yes No Question Title * 6. Smoke detectors checked and are operating properly? Yes No Question Title * 7. Emergency Lighting: Unobstructed, operational, emergency lights, and flashlights available? Yes No Question Title * 8. Combustibles stored near heat source/water heater Yes No Question Title * 9. Exits are unobstructed Yes No Question Title * 10. Evacuation maps are accurate and properly located at height of viewing Yes No Question Title * 11. Non-Approved Items (Candles, Warmers, Unapproved Space Heaters, etc.) observed Yes No Question Title * 12. Kitchen exhaust hood: maintained, clean & free of grease, inspected (oven clean) Yes No Question Title * 13. Kitchen hood extinguishing system: operational, inspected (oven and stove working properly) Yes No Question Title * 14. Proper storage in refrigerator / freezer (no mixing of meds/food/blood products) Yes No Question Title * 15. Is there food that has past expiration dates? Yes No Question Title * 16. Refrigerator/Freezers/Ice Machines: clean, maintained in good repair Yes No Question Title * 17. Kitchen: area clean, appropriately furnished; appliances are clean and in good working order Yes No Question Title * 18. The organization stores and disposes of infectious waste (such as used sharps and body fluids) in amanner that minimizes the risk of infection Yes No Question Title * 19. Chemicals are properly stored in locked closets/cabinets Yes No Question Title * 20. All sharps, including knives and scissors, are disposed of properly and locked. Yes No Question Title * 21. The organization uses standard precautions, including the use of personal protective equipment (such asgloves and face shields), to reduce the risk of infection. Yes No Question Title * 22. Latex free gloves are available Yes No Question Title * 23. Adequate separation of clean and soiled supplies Yes No Question Title * 24. Hand Hygiene procedures properly performed by staff during rounds (all sinks have hand soap, papertowels) Yes No Question Title * 25. Non-Alcohol Gel/Soap dispensers available and utilized Yes No Question Title * 26. Medication is placed in a safe or filling cabinet etc. and is locked Yes No Question Title * 27. First Aid Kits are current with no dates expired Yes No Question Title * 28. Over-the-counter medication are current (within one year) Yes No Question Title * 29. Medications are current and do not need to be destroyed Yes No Question Title * 30. The organization provides outside areas for use by clients, based on the individual’s needs and aresuitable to the individual’s age or other characteristics Yes No Question Title * 31. Landscaping: appropriate, good overall appearance, free of debris, lawn mowed, shrubs trimmed, raked,free of weeds Yes No Question Title * 32. Walkways and patios: are clean and uncluttered, used appropriately, in good condition, and resistant totrips and falls Yes No Question Title * 33. Fencing / Gates: appropriate, in good condition, secured as appropriate Yes No Question Title * 34. Exterior doors, windows, screens, etc. in good repair and operational Yes No Question Title * 35. Exterior building condition: appropriate and in good repair (paint, stucco, etc.) Yes No Question Title * 36. Exterior furniture: appropriate and in good condition Yes No Question Title * 37. Exterior lighting: appropriate and functional Yes No Question Title * 38. All windows close and open properly (they do not get stuck), if any windows are fire exits are theyaccessible Yes No Question Title * 39. Areas used by individuals served are safe, clean, and comfortable and are maintained in an orderlyfashion. Yes No Question Title * 40. Floor covering: appropriate, clean, vacuumed, and in good repair Yes No Question Title * 41. Walls: in good repair Yes No Question Title * 42. Client beds: have mattress cover, pillow with cover, sheets, blankets, as appropriate. Beds are made,and clean for new intake. Yes No Question Title * 43. Stairs: unobstructed, clean, in good repair, not storage in stairwells Yes No Question Title * 44. Furnishings and equipment reflect the ability and needs of the individual served. Yes No Question Title * 45. The organization keeps furnishings and equipment safe and in good repair. Yes No Question Title * 46. Furniture: appropriate, clean, free of tears, breakage, and free of odor. Yes No Question Title * 47. Shelves / Bracketing: appropriate and in good repair Yes No Question Title * 48. Washer & Dryers: clean, in good repair Yes No Question Title * 49. Restrooms: clean, odor free, non-slip devices in tub/shower Yes No Question Title * 50. The organization provides storage space to meet the needs of the individual served. Yes No Question Title * 51. Lighting: appropriate and functioning; is controlled by the individuals served, consistent with care, treatment, or services provided Yes No Question Title * 52. The organization maintains ventilation, temperature, and humidity levels suitable for the care, treatment, orservices provided. Yes No Question Title * 53. Vehicles meet state and city legal requirements (insurance, current registration are in vehicles) Yes No Question Title * 54. Vehicle is properly maintained and has service checks, as appropriate Yes No Question Title * 55. Vehicle drivers have completed driver safety training Yes No Question Title * 56. Vehicle drivers are listed as a driver in HR and copy of DL & Insurance is on file with HR manager Yes No Question Title * 57. What are your recommendations for any areas needing improvement? Question Title * 58. What actions have been taken to respond to the recommendations? Done
