Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 10:25 am. LPA Smith was greeted by administrator and disclosed the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 10:40 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 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 two (2) 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 metal box under kitchen sink. The resident medications and first aid kit stored in a locked kitchen cabinet next to the refrigerator. The toxins stored/locked in garage. The medications were observed to be inaccessible to residents. There are two (2) fire extinguishers: one (1) attached to back of kitchen wall next to medication cabinet and one (1) attached to wall at the end of hallway near bathroom #2. Fire extinguishers observed to be charged.

The facility has a total of six (6) bedrooms and two (2) bathrooms. There are four (4) bedrooms for residents and two (2) bedrooms for staff. 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 2 nd bathroom closet. Standalone cabinet in 2 nd bathroom stores incontinence supplies.