Facility Evaluation Report

On 9/14/23 at approximately 8:30am Licensing Program Analyst (LPA) Jennifer Fain and Licensing Program Manager Liza King arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the Hanif Khan and explained the purpose of the visit.

LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility has 4 bedrooms and 2 bathrooms for resident use. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 3 ambulatory residents and 1 non ambulatory resident.

Facility Observation: Upon entry the residents were happy to see visitors and departing for day program. LPA observed a “House Store” with items for purchase including but not limited to a song, trip to the park, arts and crafts kit. Coins used to purchase store merchandise were earn by completing daily tasks including but not limited to showering, relaxation and dialing the phone. Each resident had a laminated sheet with their name on it and a place to Velcro coins. Residents’ rooms had personal items including but not limited to posters, family photos, trains, sports memorabilia. A large wall mounted whiteboard in the family room held the calendar for the month’s appointments. A flyer on the wall listed evening activities including but not limited to karaoke, ice cream social, games night, movie night.

During this inspection 4 of 4 resident files and 4 of 9 staffing files were reviewed for regulatory compliance.

Staff files contained required contents including staff training requirements. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required.