Facility Evaluation Report

Licensing Program Analysts (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit at 9:20am. Upon arrival LPA met with Administrator Joseph Jose and explained the reason for the visit. At approx. 01:00pm, LPA 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.

Facility is a single-story residence and consists of a total of four (4) bedrooms and two (2) bathrooms. During physical plant tour LPAs observed the required postings throughout the facility.

The kitchen appeared to be clean and the appliances and fixtures functional during the time of visit. LPAs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are stored in a locked cabinet underneath the sink. Cleaning supplies were also observed stored under the sink.

The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Hallway closest near Room #3 was observed to be inaccessible to clients in care. LPA observed the closet to store PPE supplies, emergency food supplies, cleaning supplies, and other items for facility use. The hallway closet nearest bedroom #4 was observed to store a sufficient supply of linen.

LPA observed bathrooms to be clean, properly supplied and had functional fixtures. LPA observed non-skid mats. The hot water was measured in each bathroom between 111 - 115 degrees Fahrenheit

LPA observed the common areas. These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. . Medications are stored in a locked cabinet next to the fire place. LPA observed it to be inaccessible to residents in care. There is a dedicated area for the posting of required documents directly by the entry way. There is a fireplace in the living room that is non-operable at this time. It is screened and there are no tools.