Facility Evaluation Report

On 11-13-25 at 10:08am Licensing Program Analysts (LPAs) Michael Bilger and Sommer Hayes arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Adetayo Kokumo 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 is a residential care facility for the elderly (RCFE) with a current census of 3. Facility has a total of 6 bedrooms and 3 bathrooms. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 2 ambulatory residents, 1 non ambulatory resident, non-ambulatory resident receives hospice services.

Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 70*F. LPA observed the facility to have adequate food supply. Resident rooms had the required furniture and furnishings.. Smoke and carbon detectors were functioning adequately. Fire extinguisher was checked 1-15-25. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 3 resident files and 3 staffing files were reviewed for regulatory compliance. All staff noted on LIC 500 contained criminal background clearances. {Cont. on LIC 809C}