Facility Evaluation Report

On 01/13/2022, Licensing Program Analysts (LPAs) T. White and M. Jensen arrived unannounced to conduct a required Post-licensing inspection. LPAs met with Direct Support Staff, Dexter Samson and Administrator, Monalyn Andrada. LPAs explained the purpose of today’s inspection. LPAs were allowed entry into the facility that is licensed to serve a total capacity of 4 clients.

LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on April 29, 2021. First aid kit was observed to be complete. Fire drill was last conducted on 01/04/2022. LPAs observed completed mitigation plan. LPAs reviewed 1 resident file and medications. LPAs reviewed 2 staff files.

Exit interview conducted with Administrator and a copy of report given