Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Jeanette Mongeon, Administrator.

During visit, LPA Marrufo toured the facility inside and out.

LPA toured the kitchen area and observed there to be locked cabinets and drawers for cleaning supplies and sharp objects. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and found it to be complete.

LPA tested the smoke and carbon monoxide detector system and found it to function properly when tested.

LPA toured six out of six resident bedrooms and found them to have working lights and available bedding and clothing storage areas. LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured from 117 F to 119 F.

LPA toured the outside area and observed the outdoor exits were clear of obstructions.

LPA reviewed the resident records, including the Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed four staff records and found them to be complete.

See LIC809-C page for more information. Page 1 of 2.