Facility Evaluation Report

Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a Required Annual inspection. LPA was greeted by the House Manager Shalon Bowie who that advised Direct Care Staff Laura Romero would respond to assist with the visit.

LPA conducted a tour inside and outside of facility with Staff Shalon Bowie. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 114.7 degrees F. Facility was set at 77 F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 01/24/2025. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted 06/11/2025. Medications were locked in a kitchen closet in a toolbox. All cleaning supplies are locked and secured in a closet in the kitchen.

LPA reviewed staff and resident records. LPA reviewed medications and logs.

LPA reviewed the Disaster and Emergency Plan with staff.

An exit interview was conducted with Staff Laura Romero and House Manager Shalon Bowie and a copy of this report was provided.

LPA requests that updated facility sketch be provided to Licensing. Updated LIC309, LIC308, LIC500, Surety Bond, Liability Insurance, to be provided by 6/24/25. Signature of staff on this document confirms receipt.