Facility Evaluation Report

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Required Annual Inspection. LPA introduced himself and discussed the purpose of the visit with Licensee Richard Edwards. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom all (6) may be non-ambulatory.

LPA and Licensee toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. Two days worth of perishable and seven days worth of non-perishable food was present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. Both the water and ambient temperatures were at compliant readings.

No pools or bodies of water on the premises. Per Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible.

Resident records reviewed had required documentation. Staff records reviewed contained required documentation.

No deficiencies were issued on today's visit.

An exit interview was conducted with Licensee Richard Edwards, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.