Facility Evaluation Report

At 9:40 am Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by administrator and disclosed the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 9:50 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, living room/dining combination, 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 three (3) residents currently residing there. Two (2) days of perishable food 7 days non-perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps and first aid are stored in locked living room closet. The resident medications are stored and locked in living room/hall closet. Sharps and medications observed to be inaccessible to residents.

There are five (5) fire extinguishers: one behind main entry door, one in hall closet attached to wall, one in living room, one in kitchen, and in in linen cabinet in hallway.

Laundry room is located off the kitchen. The appliances observed to be functional. Toxins stored above in locked living room/hall closets observed to be locked and inaccessible to residents.