Facility Evaluation Report

On 3/2/2022 at 10:10 AM, Licensing Program Analyst (LPA) Leslie Ibo conducted a pre- licensing inspection and met with Applicant Maria Matel. This pre-licensing is a change of ownership from old facility Summit Care Home lic# 079200930. During the visit, LPA observed 4 residents resting inside each of their bedrooms and 2 residents resting in the living room, there are two staff observed during the visit.

LPA toured the entire premises indoors and outdoors. The facility has 5 bedrooms, 2 bathrooms including staff bathroom, single story house per facility sketch. All 5 bedrooms are designated for residents. There is a staff lounge located inside the garage that is empty, per applicant staff can use that If they want to rest or take a break. LPA observed 1 fire extinguishers one of which was located in the dining area. Smoke detectors and carbon monoxide detectors were observed operational. The facility received a fire clearance dated 2/1/2022 with an approval for a total capacity of 6 residents all approved for 5 non-ambulatory and 1 ambulatory with no bed ridden approval.

Kitchen and dining room floors are clean and sanitary, food preparation area has an operating ventilation fan, there are no pesticides, poisons, or other toxins stored in any food storage or preparation area, cleaning supplies are kept separate from food supply. The facility has a supply of 7 days of non-perishable and 2 days of perishable foods in stock for six people. There are enough amounts of tableware, tables, dishes, and utensils. There are enough amounts of equipment for the storage, preparation of food. All equipment and dishes are clean and in good repair and there is at least 1 dining room convenient to the kitchen. Hot water temperature was tested at 106.5 degrees Fahrenheit. Refrigerator temperature was observed at 40 degrees Fahrenheit and freezer was observed at 0 degrees Fahrenheit.