Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at 10:20 am. LPA was greeted by staff and disclosed the purpose of the visit. The administrator was present at the facility.

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 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 four (4) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in a lock box in locked in cabinet beneath oven. T

The resident medications are stored in locked medication cart in the kitchen and was observed to be inaccessible to residents. The first aid kit is stored in medication cart and stored and observed to be fully stocked.

Laundry room is located in the kitchen. The appliances observed to be functional. Toxins under kitchen sink and observed to be locked and inaccessible to residents. There are two (2) fire extinguishers: One (1) near bathroom attached to wall and one (1) in the kitchen attached to wall. Both fire extinguishers observed to be charged.