Facility Evaluation Report

On 04/12/23, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to facility to conduct an Annual Inspection. LPA was met by Ann Kristine Emperador, Administrator and explained the purpose of the visit. LPA was screened upon entry for COVID precautions. Administrator's Certificate #6039604734 Expires 06/12/2024.

LPA and staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. There is a staff break room in the garage that contains a couch and a chair. Facility is a 4 bed facility with a current census of 4. The entry door opens into an office and visitor area leading to a dining area, the living room, kitchen with a hallway to the bedrooms and bathrooms. LPA Campbell reviewed 2 of 4 client files and 2 of 6 staff files.

Hot water temperature was measured at 112 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster and Fire cliearance form.. Fire extinguisher was last inspected on February 14, 2023. Smoke and carbon monoxide alarms were tested and found to be functioning. Cleaning supplies, toxins and sharps were locked away from residents.

No deficiencies were cited during this inspection.

Exit interview conducted. Appeal Rights and a copy of this report provided .