Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson met with Licensee to conduct Annual Licensing Inspection. There are currently no residents in care.

LPA inspected Physical Plant, Common Areas, Bedrooms, Bathrooms, Kitchen, Food Service, Medication and Records. Common area was clean and in good repair. All bedrooms had required furniture, bedding and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Facility has required (7) seven day non-perishable and (2) day perishable supply of food. Centrally stored medication was properly stored and locked away.

Administrator certificate is current. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured 108.5 degrees. All employees requiring background checks are cleared. Facility has required liability insurance policy. All required postings are displayed within facility. As a result of this inspection,

No deficiencies were cited, per Title 22 Regulations, Division 6.

Exit interview with Administrator and report provided.