Facility Evaluation Report

At 1:05 pm Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by facility staff and disclosed the purpose of the visit. LPA Smith’s temperature was taken upon entry and the administrator was contacted. LPA Smith spoke to the administrator and the administrator revealed is unable to come to the facility due to personal issues and authorized facility staff to sign.

LPA conducted a tour of the physical plant at approximately 1:18 pm 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 kitchen, living room/dining combination, family room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with 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 six (6) residents currently residing there. Two (2) days of perishable food 7 days non-perishable food observed. The freezer is stocked with meats and frozen vegetables. The resident medications are stored and locked in upper kitchen cabinet. Sharps are locked in upper kitchen cabinet next to sink. Both medications and sharps observed to be inaccessible to residents.

Toxin are locked under kitchen sink cabinet; observed to be locked an inaccessible to residents.

The facility has a total of six (6) bedrooms and four (4) bathrooms. The resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens in hall closet.