Facility Evaluation Report

At 9:15 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 present in the facility.

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, kitchen, and 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 six (6) 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. There are two (2) additional stocked refrigerators in the garage. Canned goods and extra supply of food stored in pantry hall closet #1. Sharps/toxins stored and locked under kitchen sink; observed to be inaccessible to residents. Medication store in medication cart and observed to be inaccessible to residents.

There are two (2) fire extinguishers: one (1) attached to wall in kitchen, and one (1) attached to wall in hallway near exit. Both fire extinguishers observed to be charged.

Laundry room is in the garage. The appliances observed to be functional. Two fully stocked first aid kits stored in hallway closet#2.