Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an announced Annual Required visit and inspection of the facility. The facility is currently under renovation, and there were no residents present. LPA met with Administrator Editha Tagum, and at approximately 12:20 p.m., with the Administrator's assistance, LPA took a tour of the physical plant. Required postings were observed in the dining area. There are functional smoke alarms and carbon monoxide detectors. LPA observed the kitchen to be clean, and the kitchen appliances are functional. Knives were stored in a locked drawer in the kitchen. Bedrooms: There are six (6) bedrooms in the facility. Five (5) bedrooms are designated for residents' use and one (1) is designated for the staff. All bedrooms were furnished with appropriate bedding and linens, and had sufficient lighting. Bathrooms: There are three(3) bathrooms designated for residents' use. The facility had water shut down due to the renovations, and thus LPA was unable to measure the hot water temperature. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. The dining room table is large enough to seat the capacity of the facility. Seating, such as couches, where in good repair and seats the capacity of the facility. Surrounding Grounds: There was furniture appropriate for outdoor use. There is a swimming pool that is fenced all around its perimeter. The fence was at least five feet high with a gate that was also five feet high. Gate was observed locked. LPA observed old furniture and other storage boxes in the backyard. Garage/ Laundry area: LPA observed the garage to be used as storage. LPA also observed the washer and dryer. Staff Files: LPA conducted a file review of the Administrator to ensure forms and training are up to date and in compliance with licensing forms. Temperature: Facility Air conditioning system is currently under renovation.

There were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.