Facility Evaluation Report

Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Annual required visit to the above fa cility using the new Care Inspection tool. LPA was met by Staff Leonardo Zuniga, the purpose of today’s visit was explained. There are currently (4) residents in the facility . (3) residents are ambulatory and (1) is non-ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists (4) bedrooms, (2) full bathrooms, shaded back yard, front area, laundry area and attached garage. The facility is located in the back house

LPA Antonine Richard and Leonardo Zuniga toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. The bathrooms are clean and operational. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Residents Medications and files are current. LPA Antonine Richard reviewed resident file and medication record. LPA reviewed staff files. Staff files are not current. Food supply of perishable and nonperishable food is within title 22 regulations. The Hot water temperature tested 117.5F degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 1 fire extinguishers were fully charged. First Aid kit complete and with Manual LPA observed scissors tweezers and thermometer. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit .