Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 9:35 am. LPA Smith was greeted by staff and disclosed the purpose of the visit. Staff contacted the administrator. LPA Smith spoke with the administrator and disclosed the purpose of the visit. Administrator revealed spouse who is also an administrator will arrive shortly.

LPA conducted a tour of the physical plant at approximately 10:20 am to ensure there are no health and safety hazards, and the facility follows Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs of residents. These included the kitchen, dining room area and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately.

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 and seven (7) days of nonperishable food observed. The freezer is stocked with frozen foods. The residents’ medications are locked in cabinet in the kitchen and observed to be locked and inaccessible to residents. Sharps are locked in kitchen island drawer observed to be locked and inaccessible to residents. The stocked first aid kit is stored above the medication cabinet in the kitchen. There are five (5) fire extinguishers: One (1) attached to the wall in the kitchen and four (4) in laundry room with one (1) attached to the wall. Fire extinguishers observed to be charged.

The laundry room is located at the end of the first hallway by enclosed patio. The appliances observed to be