Facility Evaluation Report

Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:43AM. LPAs initially met with facility staff. Administrator was contacted via telephone and arrived at the facility at 12:20PM. Entrance interview conducted.

Beginning at 12:25PM, the LPAs, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

Fire extinguisher is fully charged and last serviced on 03/27/2023. Hardwired smoke detectors were tested at 04:34PM, separate carbon monoxide detector was tested at 04:35PM and all were functional at the time of the visit. Fire pulls were tested during January 2023 fire inspection. No fire clearance concerns were observed during today's visit.

BEDROOMS : There are six (6) total bedrooms in the facility; five (5) bedrooms are designated for resident use and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

KITCHEN : The LPAs observed the kitchen. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Knives were locked in a kitchen drawer. At 12:35PM, LPAs observed cockroaches around the refrigerator, inside kitchen cabinets, and on the kitchen floor.

COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be properly furnished at the time of the visit. A fireplace was noted in the living room to be covered and Report Continued on LIC 809-C