Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 10:30 am. LPA Smith was greeted by administrator and disclosed the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 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 residents. These included the kitchen/dining room combination, living room and family room. 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 five (5) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked metal locker in kitchen. The resident medications and first aid kit stored in locked metal locker in kitchen and observed to be inaccessible to residents. There is one (1) fire extinguisher attached to dinning room area wall next to the kitchen. Fire extinguisher observed to be charged.

Laundry room is in attached garage. The appliances observed to be functional. Toxins stored in

locked cabinet in garage and observed to be locked and inaccessible to residents.

The facility has a total of four (4) bedrooms, two (2) bathrooms, and half bathroom off kitchen: three (3) shared bedrooms for residents and one (1) bedroom for staff. Two (2) bathrooms are for residents use.