Facility Evaluation Report

Licensing Program Analyst (LPA), Tihesha Smith a conducted an unannounced Required 1-year inspection at this facility, met with administrator and disclosed staff the purpose of the visit. LPA conducted a tour of the physical plant at approximately 10:20 am to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs of the residents. These included the kitchen with breakfast nook area, formal dining room and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to 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 six (6) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meat and frozen vegetables. Additional refrigerator in detached garage with excess food items. Resident medications and stocked first aid kits stored in cabinets in laundry area. Medications observed to be locked and inaccessible to residents in care. Toxins are stored and locked in the laundry room in the lower cabinet. The cabinet containing the toxins observed to be locked and inaccessible to residents.

The sharps are stored in the same locked cabinet as the toxins. The wall attached fire extinguisher is located in the breakfast nook area. The appliances observed to be functional. The laundry room is located at the back of kitchen.