Facility Evaluation Report

At 8:50 am Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by facility staff and disclosed the purpose of the visit. The administrator was contacted, and the Licensee and Administrator arrived later.

LPA conducted a tour of the physical plant at approximately 9:30 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 living room and kitchen/dining 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 five (5) residents currently residing there. Two (2) days of perishable food 7 days non-perishable food observed. The freezer is stocked with meats and frozen vegetables.

Sharps stored and locked in kitchen drawer and medications are stored in locked hall closet next to main entry door. Sharps and medications observed to be inaccessible to residents. There is one (1) fire extinguisher: attached to wall in kitchen.

Laundry room is located through the kitchen in separate alcove area. The appliances observed to be functional. Toxins stored in cabinets across from washer and dryer and observed to be locked and inaccessible to residents.

The facility has a total of five (5) bedrooms and three (3) bathrooms. The resident bedrooms were properly