Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. This annual had a specific emphasis on infection control practices and procedures. Upon arrival, LPA met with facility staff Dilbert Puno and explained the reason for today's visit. Administrator Michelle Maurer was contacted via telephone at 10:15AM and was unavailable at the time of the visit. Administrator verbally authorized facility staff Dilbert Puno to sign today's report. Entrance interview conducted.

At 10:29AM, LPA, along with facility staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

Common Areas : These included the living rooms and dining areas. The common areas were checked for cleanliness and good condition. All common areas were properly furnished at the time of the visit. Medications were observed to be locked in a cabinet in the hallway next to garage door.

Smoke alarms were tested at 10:42AM and were functional at the time of the visit. Carbon monoxide detector was tested at 10:46AM and functioned properly. The fire extinguisher was fully charged and purchased 09/30/2022.

Bedrooms: There were four (4) bedrooms total with one (1) bedroom designated for staff use. All three (3) resident bedrooms are designated as shared rooms. All bedrooms for resident use were properly furnished and had appropriate bedding and linens. LPA observed staff room to be locked at the time of the visit.

Bathrooms: There were two bathrooms designated for resident use. Both bathrooms appeared clean,