Facility Evaluation Report

Licensing Program Manager (LPM) Simon Jacob and Licensing Program Analyst (LPA) Amy Rodgers made an unannounced visit to the facility to conduct a post-licensing inspection. LPA was met by Assistant Regional Director Mitch Blackwood and granted entry into the facility and discussed the purpose of the visit.

A tour of the facility was conducted inside and out. LPM and LPA, accompanied by Mr. Blackwood conducted a general overall inspection, which included, but was not limited to the following: Facility physical plant, food service, care and supervision, medication, record review and facility administration. Administrator Certificate for Olayinka Ajetunmobi expires on May 19, 2025.

During today's inspection, LPA observed the following: All indoor and outdoor passageways were free from obstructions. No pools or bodies of water were observed. Per Blackwood, there are no firearms or other dangerous weapons in the facility. Poisons and cleaning agents were observed to be inaccessible to clients in care. LPA toured each room in the facility. Rooms designated as client bedrooms had the required furnishings and sufficient lighting available for clients. Licensee provided each client with clean linen in good repair and sufficient hygiene products for personal use. The hot water temperature measured at 105-120 degrees F. The facility had multiple functioning carbon monoxide detectors and multiple smoke detectors. There was an operable fire extinguisher present in the facility. The facility was stocked with a two (2) day supply of perishable and seven (7) day supply of nonperishable food items. Medications were stored in a locked medication cart and were labeled and maintained in compliance with label instructions.

Based on today's visit, deficiencies were observed and cited at this time of the visit. A copy of this report, along with the 809-Ds, and Licensee/Appeal Rights, was provided to Mr. Blackwood at the conclusion of the visit, and signature on this form acknowledges receipt of these rights.