Facility Evaluation Report

On 8/26/22 Licensing Program Analyst (LPA) Maja Jensen arrived at facility announced to conduct a pre-licensing visit. LPA Maja Jensen met with Administrator Athika Karolia and Administrator Sharene Kacyra and explained the purpose of today's visit.

The facility is a single story structure with a wrought iron gate in the front yard and a redwood fence in the backyard. The grounds are landscaped and free of obstruction. The facility was observed to be sanitary and free of odor. The facility is licensed for 4 and can accept up to three clients that are non-ambulatory. Facility sketches are posted throughout and are in compliance. The facility was equipped with adequate lighting. LPA Jensen toured the facility including but not limited to dining room, kitchen, living room, bedrooms, office, laundry room, garage and grounds. There is a barn on the premises that is not part of the facility and will remain locked.

The kitchen was observed to be fully equipped and all drawers and cabinets are labeled. Knives and sharp objects are locked and inaccessible to residents. Toxins and cleaning supplies are locked and inaccessible to residents. Snacks are easily accessible to residents. 4 of 4 bedrooms were observed to be adequately furnished. There was an ample supply of linens available. The bathroom water temperature was measured at 108 degrees. The bath/shower areas are built with non-slip flooring material. The kitchen water temperature was measured at 111 degrees. The water bacteriological analysis was completed on 7/25/22 and was reviewed and is in compliance. The facility retains 4 first aid kits that are complete with manual, scissors, tweezers, thermometer and various wound dressings. There are two emergency supply kits with enough supplies for 5 people each. The fire alarm is combined with the carbon monoxide detector and was determined to be in good working order.