Facility Evaluation Report

On 08/13/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct required Annual inspection. LPA introduce self, stated the purpose of the visit, and met with House Manager Diana Diaz. Administrator Jaimy Johnson who stated unable to attend meeting. LPA toured facility with House Manager. All three residents observed during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Medications and sharps observed kept locked in hall closet. An adequate supply of perishable and non-perishable food was observed. Fire extinguisher was observed with a service date of: 6/10/24. Last fire drill completed 08/09/24. Temperature maintained for refrigerator at 37 degrees F and freezer at 0 degrees F. All bedrooms were toured and observed to be required furniture and adequate lighting. Toilet observed functional and operational. Hot water temperature was tested 117.5 degrees F in bathroom 1 and 115.7 degrees F in shared bathroom. Chemicals were observed stored and locked under kitchen sink. Outside of facility toured and observed to be free of debris. Adequate outside seatings observed available for resident. Carbon monoxide and smoke detector observed operational during inspection.

Exit Interview conducted. A copy of this report was provided to House Manager, whose signature on this form confirms receipt of this report.