Facility Evaluation Report

On 11/12/2021 at 10:45 am, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA Truong called and spoke to staff, whom confirmed no clients or staff have had any symptoms of COVID-19 in the last 10 days. Upon LPAs arrival, Caregiver, Jennifer Willis was present at facility and contacted Assistant Administrator, Janae Dosty who arrived a bit later. LPA met with Janae Dosty explained the purpose of the visit.

Administrator holds current certification #6022970735 and expires on 12/2/2022. The facility is licensed to serve six (6) ambulatory clients. There are currently five (5) clients who reside at this facility. LPA toured the facility with Janae Dosty on 11/12/2021 at 11:20 am.

LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 110.6 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable.