Facility Evaluation Report

Licensing Program Analysts (LPAs),Abdoulaye Zerbo and Armando Perez conducted an unannounced visit to the facility for a health an safety check. The LPAs met with caregiver Kathleen Davis, and informed her of the purpose for the visit and were granted access.

The facility is a single story building and consists four (4) resident bedrooms and two (2) bathrooms. There are currently two (2) residents in care. LPAs toured the facility for the purpose of a health and safety check. LPAs observed eleven(11) out of twelve(12) items to be expired in the emergency backpack. A citation will be issued. LPAs observed the licensee not to have a current administrator's certificate. A citation will be issued.

LPAs were not able to obtain the LIC 500 and LIC 9050 as the facility did not have them on site. A citation will be issued. LPAs observed current personnel to be fingerprint cleared and listed on the facility's personnel report.

An exit interview was conducted, and a copy of this report was provided to caregiver Kathleen Davis.