Facility Evaluation Report

Licensing Program Analyst LPA Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Lori Wyatt. LPA disclosed the purpose of the inspection and was granted entry into the facility by DSP Ashley Williams.

A tour of the facility was conducted with House Supervisor Angela Gonzalez. The residence was set at 68 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 3 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 110.9 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked cabinet. Medications were stored in a locked Medication cabinet. Cleaning supplies were in a locked closet. First Aid Kit contained the required supplies. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 1/17/23. Fire drill was last completed on 3/06/23.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents.

Resident and staff records were reviewed. Current first aid and CPR were on file for staff.

Per Title 22, citation was issued for incomplete resident records. Refer to 809D.

An exit interview was conducted with House Supervisor Angela Gonzalez. A copy of this report was left with House Supervisor Angela Gonzalez, whose signature on this form confirm receipt of these documents.