Facility Evaluation Report

On 10/18/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Direct Support Personnel (DSP), stated the purpose of the visit and was allowed entry into the facility. Administrator was contacted and was available at the time of visit. DSP provided a tour of the facility inside and out.

LPA observed 1 resident in care at the time of visit. Facility is a 3 bedroom 2 bathroom home. Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction. Facility temperature was 76 degrees F. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 118 degrees F.

Medications were observed to be locked medication cabinet located in the laundry room. Cleaning supplies were observed to be locked closet next to the entry way. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. There are no residents with Restricted Health conditions in the facility.

Carbon monoxide and smoke detectors were tested and observed to be operational Fire Extinguisher was observed with a service date of 05/12/2023 . First aid kit was observed and contained all required items. A working phone line was observed to be available for residents in care. A sample of resident and staff files were reviewed and observed to have the required documents.

The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed for residents in care. Side gate was self-closing and self-latching. (Continued from 809-C)