Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff and explained the reason for the visit. Administrator David Kawooya was contacted and arrived shortly after. At approximately 10:30 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detectors functioned properly. The fire extinguisher is in the dining area, and the purchase date is 12/19/25.

Kitchen: The kitchen appliances and fixtures were functional. LPA found sufficient perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the hallway cabinets. The laundry area is adjacent to the kitchen.

Bedrooms: There were four (4) bedrooms designated for clients' use. All four (4) bedrooms are designated for private use. LPA inspected (3) out of (4) bedrooms, in use by clients; three (3) out of 4 were properly furnished with appropriate beddings and linens, with sufficient lighting.

Bathrooms: There are three (3) bathrooms designated for clients' use. LPA inspected the main bathroom, which was properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 109.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in the main bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. LPA observed the office/workstation area were the Administrator uses. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. (Continue on 809C)