Facility Evaluation Report

On 11/23/2024 at 11:30 AM, Licensing Program Analyst LPA) Jose Calderon conducted an unannounced annual inspection visit at the Polly’s Place Facility. LPA Calderon was allowed entry into the facility by Administrator Polly Valencia. Administrator Valencia asked infection control questions and took LPA Calderon temperature prior to entrance into the facility. Facility is to operate a Residential Care Facility for 6 Elderly residents 60 years or older. Currently, there are six (6) residents residing in the facility, 60 and older.

LPA Calderon explained to Administrator Valencia, the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Six (6) client service records, six (6) client medication records (MAR), three (3) staff records, and inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 10/01/2024 . The one-story residential home consists of six (6) client bedrooms, seven (7) client bathrooms, living room, dining room, kitchen, staff room, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the garage and kitchen area.