Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma met with the assistant administrator, Eddie Provost, for a Required One (01) Year visit. LPA explained the reason for the visit. Eddie Provost designated Darwin Jalova as the person to sign and accept this report. A tour of the physical plant was conducted at 12:20 PM and the following was noted:

There is one entrance being utilized at the facility. The facility has a total of five (05) bedrooms and two (02) bathrooms for both residents and staff. The facility is fire cleared for six (06) non-ambulatory of which one (01) may be bedridden, and a hospice waiver for two (02). The facility is currently occupying five (05) residents.

The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for laundry and storage. Laundry detergents, cleaning agents and other toxins are locked away.

Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents.

The living and dining room are neat and clean. The facility thermostat reading was 68°F at the time of the visit.