Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility 11:25 am. LPA disclosed to the administrator the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 11:30 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 loving/dining room combination, and kitchen. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be clean, sanitary and 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 foods. Food pantry in kitchen stocked with can goods and boxed foods. Resident medications and sharps are stored in lower kitchen cabinets next to stove. Medications and sharps observed to be locked and inaccessible to residents in care. Two (2) new first aid kits stored in large cabinet in living room. Toxins are stored and locked under kitchen sink and observed to be locked an inaccessible to residents. There are two (2) fire extinguishers in facility attached to the wall: One (1) in entry hallway and one (1) in kitchen; both observed to be charged.

Laundry room is located in alcove at back of kitchen. The appliances observed to be functional. The locked cabinets above washer and dryer contain laundry detergents and supplies.