Facility Evaluation Report

At 10:05 am, Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by the administrator and disclosed the purpose of the visit.

LPA conducted a tour of the physical plant at 10:45 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 of residents. These included the livingroom, Kitchen, and 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 and sufficient for the four (4) residents currently residing there. Two (2) days of

perishable fruits, vegetables, milk, and eggs observed. The freezer is stocked with meats and frozen

vegetables. Sharps are stored in a lock box on counter next to refrigerator. The resident medications are stored in locked medication cart in the living room and was observed to be inaccessible to residents. The first aid kit is readily available and stored in cabinet area next to bathroom and observed to be fully stocked. There are two (2) fire extinguishers: One (1) in Livingroom attached to wall and one (1) in the laundry room. Both fire extinguishers observed to be charged.

Laundry room is located near main entry door. The appliances observed to be functional. Toxins stored in locked bathroom cabinet was observed to be locked and inaccessible to residents.

The facility has a total of four (4) bedrooms for residents and two (2) bathrooms for