Facility Evaluation Report

Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a Required - Annual visit on 05/01/2023 at approximately 8:45 am. Administrator Certificate expires for Tanneh Koayen on 07/09/2023.

LPA met with Tanneh Koayen and discussed the purpose of the visit. The facility is licensed for a capacity of 4 residents.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed residents who were engaged in their own respective activities during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 71 degrees, which is within the required range of 68-85*F. The hot water temperature was measured at 117 degrees Fahrenheit which is within the required range of 105-120*F.

LPA observed fire extinguisher(s) inspected on 04/10/2023, smoke and carbon monoxide detectors in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

Upon a file review the following items were discussed to be submitted with any changes annually:

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Exit interview held, copy of report given.