Facility Evaluation Report

On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by facility staff. Designated Person was available to assist with the annual inspection. LPA began a tour of the facility and observed the following.

The facility is a two storied home equipped with six bedrooms three of which are utilized for residents in care, one of which is vacant, and one of which is utilized by an individual who rents a room located on the second floor. Additionally the facility is equipped with three bathrooms, and an attached two car garage. LPA observed kitchen area to be clean and free of any mildew and debris. LPA observed kitchen area to have a dishwasher, refrigerator, gas stove, and a microwave. All appeared to be in good repair and tested operational. LPA observed facility to have a two day supply of perishable food, a seven day supply of non-perishable food, and a sufficient amount of emergency water on hand.

LPA observed all resident bedrooms to be large enough to walk about freely and to accommodate all required furnishings. The bedrooms were observed to be equipped with the following: A chest of drawers, a bed, clean linens in good repair; meaning no strains or tears, a chair, a reading lamp, and enough storage space to store personal belongings. LPA observed all restrooms to be clean and free of any mildew and debris. LPA observed restrooms to have operational toilets and faucets, additionally the restrooms have all required furnishings such as grab bars, slip resistant floor matts, and a shower chair available. Hot water temperature tested between 132.3 and 133.4 degrees Fahrenheit a deficiency was issued on today's date.