Facility Evaluation Report

Licensing Program Analysts (LPA) Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 8:20 am. LPA disclosed to staff the purpose of the visit and the administrator was contacted. The administrator was not available to come to facility and authorized staff to sign.

LPA conducted a tour of the physical plant at approximately 9:15 am 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 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 four (4) residents currently residing there.

The resident medications are locked in a cabinet on top of desk in office area. The medications were observed to be inaccessible to residents. There is one (1) fire extinguisher located in the kitchen attached to wall. Fire extinguisher observed to be charged.

The facility has three (3) bedrooms and three (3) bathrooms: There is also a converted room that is currently used as a couple resident room.

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.