Facility Evaluation Report

Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced Required - 1 Year annual visit to the above facility. Upon arrival LPA met with administrator Yana Diaz who was observed wearing a mask.

LPA conducted a tour at 11:15 AM of the physical plant to ensure there are no health and safety

hazards and facility following Title 22 Regulations The facility has six (6)

interconnected smoke alarms and carbon monoxide alarms that are hard wired and battery

operated. All smoke alarms were tested and function properly. The carbon monoxide detector was

tested and functions properly. The fire extinguishers were current with receipt.

Administrator confirmed there are two (2) residents residing in the facility. The living/dining combination area had sufficient lighting, adequate seating, was clean and properly furnished.

The kitchen appeared clean, the appliances and fixtures were functional. The kitchen food supply

was observed and sufficient for the two (2) clients currently residing there. Two (2) days of

perishable fruits, vegetables, milk and eggs observed with water and juices. The two kitchen freezers were stocked with meats and frozen vegetables. The locked garage stocked was

stocked with non-perishable food, canned goods, water and PPEs. The

sharps are locked in a drawer next to sink.

The resident’s medications are locked in kitchen top cabinet near kitchen sink and first aid kit attached to cabinet door next to the medication cabinet.