Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit. LPA met with Licensee and stated the purpose of today’s visit. Facility is licensed to serve a total capacity of

LPA toured physical plant with Administrator inside and outside to ensure the safety of the residents. All required furniture were observed. LPA observed (2) residents resting in bedrooms and the other (3) residents are at day programs. LPA observed the facility conducts fire drills monthly and last drill was 4/4/2022. All required COVID-19 measures were observed. LPA observed staff and Licensee/Administrator wearing a mask. Staff took LPA temperature and a sign in sheet for visitors was at front door. Visitors are not allowed in the home due to COVID-19 pre-cautionary measures, but can visit residents in the backyard. LPA observed signs and postings. LPA observed outside fencing in good condition. LPA observed garage cleared out and extra freezer in corner. The thermostat temperature inside the facility hallway was measured at 73 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water measured at 107.2 *F which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA observed a pull alarm system, fire extinguisher(s) expire 07/05/2022, smoke and carbon monoxide detectors in working order, and central heating and air in the facility. LPA observed cleaning supplies and toxins locked up in the kitchen and laundry room. LPA observed a washer and dryer ready in use. LPA observed the backyard with a locked shed.