Facility Evaluation Report

Unannounced annual visit made out to this facility on 10/20/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Bokime Etim at this time. A brief interview was conducted with the facility designated Administrator at this time.

This facility was licensed to accept and retain up to 6 residents at any given time. This facility was also vendorized through Valley Mountain Regional Center and able to accept and accept Level 4I residents at any given time.

Current census was 4 residents of which only (1) resident was present in the facility while the other (3) were out of the facility at this time. It was learned that they were out at their respectable day programs or school.

Kitchen area was toured. Cabinets and drawers were reviewed.

Medication cabinets were observed to be present and properly locked to make them inaccessible to the residents at all times. Policies and procedures were discussed with the facility designated Administrator in terms of dispensing, documenting, and overall administration of resident medications.

First aid kits were observed to be present and contained all of the necessary components at this time.

Policies and procedures were discussed in relation to narcotics and medications that required a separate count and documentation by incoming staff and outgoing staff. A review was conducted in regards to this documentation of the resident narcotics.

A tour of the facility resident rooms was conducted. Resident furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

Resident restrooms were toured and observed to be able to meet the needs of the residents at this time.

Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees at this time.

Living area, dining area, and all other areas intended for resident use were toured and observed to be in compliance at this time.

Fire extinguishers (2), located in the dining area and facility entrance way, were observed to have been