Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility 10:25 am. LPA disclosed to the staff the purpose of the visit. The administrator was present at the facility.

LPA conducted a tour of the physical plant at approximately 10:38 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 room, dinining room, and kitchen. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be clean, sanitary and have adequate seating for residents. Office area in dining room.

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. The freezer is stocked with meats and frozen foods. Food pantry located in laundry room stocked with vegetables and boxed foods. Resident medications locked in closet near entry. Sharps and toxins are stored and locked under kitchen sink and observed to be locked an inaccessible to residents. There is one (1) fire extinguishers in facility attached to the wall in kitchen and observed to be charged.

Laundry room is located in separated room at side of kitchen. The appliances observed to be functional. The locked cabinets above washer and dryer contain laundry detergents and supplies.