Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 12:55 pm. LPA disclosed to staff the purpose of the visit and the administrator was contacted.

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 living/dining room combination, and kitchen. The common areas were checked for cleanliness and furniture was checked for functionality and observed to be in good condition. 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. There are two (2) refrigerators :(1) in the kitchen and (1) in Office/staff room. Both stocked with meats, eggs, milk, vegetables and frozen foods. Resident medications are stored in lower kitchen cabinets. Sharps store in kitchen drawer. The toxins are stored under kitchen sink. The medications, sharps, and toxins 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 is one (1) fire extinguisher in facility attached to kitchen wall. Fire extinguisher observed to be charged.

Laundry room is located in office/staff room. The appliances observed to be clean and in good repair. The locked cabinets in laundry room contain laundry detergents and supplies.