Facility Evaluation Report

On 11/7/23 at approximately 10am Licensing Program Analyst (LPA) Jennifer Fain arrived at this facility unannounced to conduct an annual inspection visit. LPA met with Amellie Diouf and explained the purpose of the visit.

LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility has 4 bedrooms and 3 bathrooms for resident use. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 6 ambulatory residents.

Facility Observation: Upon entry the residents were away at day program. Resident rooms had personal items including but not limited to photos, posters, artwork jewelry and clothing. Rooms and closets were tidy and the beds were made. Dining table had labeled place mats. Staff were cleaning and making dinner.

During this inspection 2 resident files and 1 staffing file were reviewed for regulatory compliance.

Staff 1 was missing training for 2222 and 2023 and had an expired CPR/ first aid certificate. Staff 2’s file was not at the facility. LPA spoke to administrator by phone. Administrator will email required documents. LPA Fain was unable to ascertain if the staff on duty were associated to the facility.

Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required.

Water temperature in common bathroom reads 110.3* F which is within the regulated temperature range of 105*F to 120*. Temperature on the heating and air unit read 70*F.