Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 10:35 am. LPA Smith rang doorbell no answer. The administrator was contacted by LPA Smith and arrived later. Upon arrival Administrator greeted LPA and LPA revealed purpose of the visit.

LPA conducted a tour of the physical plant at approximately 11:20 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. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. The resident medications are locked in upper cabinet in kitchen and observed to be locked an inaccessible to residents in care. The first aid kit is attached to wall in kitchen near medications. Sharps are stored in medication cabinet and observed to be locked and inaccessible to residents.. The medications were observed to be inaccessible to residents. There is one (1) fire extinguisher attached to wall in dining area. Fire extinguisher observed to be charged.

Laundry room is in hallway near main entrance. The appliances observed to be in good repair. Toxins stored in laundry room cabinet. Toxins observed to be locked and inaccessible to residents.

The facility has a total of five (5) bedrooms and two (2) bathrooms. There are four (4) private bedrooms for residents and one (1) bedroom for staff and one (1) bathroom for residents.