Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at 09:55 am. LPA observed front yard and grounds. LPA Smith was greeted by staff and disclosed the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 10: am to ensure there are no health and safety hazards, and the facility is following Title 22 Regulations. Common areas—including the combined living and dining room, as well as the kitchen and den were evaluated for their ability to safely meet resident needs. These spaces were inspected for cleanliness, and furniture was assessed for functionality and condition. The common areas were found to be clean, sanitary, and furnished with seating sufficient to comfortably accommodate the residents and/or prospective residents.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The

kitchen food supply was observed to be sufficient for the four (4) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meat and frozen foods. Resident medications are stored in wall mounted metal cabinet in dining area. Medications observed to be locked and inaccessible to residents in care. Sharps are locked in kitchen drawer next to oven and observed to be inaccessible to residents. Toxins are stored and locked in pantry room, in main bathroom, bottom cabinet and in garage. Toxins observed to be inaccessible to residents. There is one (1) fire extinguisher attached to wall in kitchen and observed to be charged.