Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility 2:20 pm. LPA disclosed to the administrator the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 3:52 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/dining room combination and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to 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 four (4) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Food pantry in closet next to refrigerator. Sharps and toxins are locked under kitchen sink cabinet. Resident medications stored in locked top kitchen cabinet and observed to be inaccessible to residents. Three (3) first aid kits stored in locked kitchen island cabinet observed to be fully stocked. There is one (1) fire extinguisher attached to wall in the kitchen and observed to be charged.

Laundry room is located across from garage door. The appliances observed to be functional. Additional toxins stored in laundry room open shelves. The laundry room observed to be locked an inaccessible to residents in care.

The facility has a total of four (4) bedrooms and two (2) bathrooms for residents. No room designated for staff. The resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident.