Facility Evaluation Report

Licensing Program Analyst (LPAs), Tihesha Smith and Gina Saucedo conducted an unannounced Required 1-year inspection at this facility 10:35 am. LPA disclosed to the administrator the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 11:10 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 sitting room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to have 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 food observed. The freezer is stocked with meats and frozen vegetables. Food pantry located in laundry room. Resident medications and two (2) stocked first aid kits stored in large cabinet in laundry area. Medications observed to be locked and inaccessible to residents in care. Toxins are stored and locked in laundry room in wardrobe cabinet. The cabinet containing the toxins observed to be locked and inaccessible to residents.

The sharps are stored in locked metal cabinet in laundry room. There is one (1) fire extinguisher attached to wall in the kitchen and observed to be charged.

Laundry room is located across from garage door. The appliances observed to be functional.