Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at 8:30 am. LPA was greeted by staff and disclosed the purpose of the visit. The administrator was not present at the facility upon LPA Smith arrival.

LPA conducted a tour at 8:55 am of the physical plant 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 and kitchen/dining room combination. 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 three (3) residents currently residing there. Two (2) days of

perishable food observed. The freezer is stocked with meats and frozen vegetables. Pantry next to refrigerator stocked with dry boxed food and canned goods.

Sharps and first aid kit are locked in kitchen drawer. The resident medications are locked in upper kitchen cabinet and observed to be inaccessible to residents. There is one (1) fire extinguisher attached to dining room wall: observed to be charged.

Laundry room is located past kitchen. The appliances observed to be functional. Toxins stored and locked in cabinets across from washer/dryer. Toxins cabinet observed to be locked and inaccessible to residents.

The facility has a total of six (6) bedrooms and three (3) bathrooms: there are three (3) bedrooms and two (2) bathrooms for residents and two (2) bedrooms for staff.