Facility Evaluation Report

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Jacqueline Tucker and District Manager Mauricio Villatoro. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Administrator.

A tour of the facility was conducted with the Administrator. The residence was set at 74 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 5 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 120 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked closet. Medications were stored in a locked Medication closet. Cleaning supplies were in a locked cabinet. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 4/10/23. Fire drill was last completed on 06/28/23. Facility has a pull station fire alarm.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents. Facility has a pool that is gated and locked to be made inaccessible to residents in care.

Resident, medication and staff records were reviewed and found to be complete. Current first aid and CPR were on file for staff.

An exit interview was conducted with the Administrator. A copy of this report was discussed and left with the Administrator, Jacqueline Tucker, whose signature on this form confirm receipt of these documents.