Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at 12:00 pm. LPA contacted the administrator for point of entry. The administrator was present at the facility and came to the front gate.

LPA conducted a tour of the physical plant at approximately to ensure there are no health and safety hazards and facility is following Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs of residents. These included the kitchen and living room/dining area 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. There is sufficient for the three (3) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked cabinet in kitchen island. The resident medications are stored in locked upper cabinet in the kitchen. The medication and sharps were observed to be locked and inaccessible to residents. The first aid kit is stored in hall closet #1/pantry.

Laundry room is located outside in shed. The appliances observed new, clean, and functional. Toxins under kitchen sink and observed to be locked and inaccessible to residents. There is one (1) fire extinguisher: attached to the kitchen wall observed to be charged.