Facility Evaluation Report

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

LPA conducted a tour of the physical plant at 12:55 pm 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 living room, 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 adequate supply of meats and vegetables.

Sharps are stored in a lock box under kitchen counter and the medication stored in cart in the living room with both observed to be inaccessible to residents. The first aid kitss are readily available and stored in medication cart 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 and two (2) bathrooms for residents.