Facility Evaluation Report

Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing visit with administrator Daniel Sagal. Identification of the Applicant/Administrator was verified by photo ID.

The facility has a capacity of six (6). Application received for six (6) Non-ambulatory residents.

LPA conducted a tour of the physical plant at approximately 10:50 am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs residents. These included the living room, dining room combination, kitchen, and family area. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be clean, sanitary and have adequate seating for residents.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The

kitchen food supply was observed and sufficient for the five (5) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen foods. Sharps are stored in kitchen drawer. Sharps observed to be locked and inaccessible to residents in care. First aid kits stored in upper cabinets in living room. Toxins are stored and locked under kitchen sink and observed to be locked and inaccessible to residents.

There are two (2) fire extinguishers in the facility: One (1) attached to the kitchen wall and one (1) attached to wall in family area. Both fire extinguishers observed to be charged.

Laundry room is located at the back of the kitchen.