Facility Evaluation Report

At approximately 1:00 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to BEGIN a required 1-year annual inspection and was greeted by Administrator Maria Batungbakal

Facility is an Adult Residential Care Facility licensed for six (6) ambulatory clients. Gannet Prime is currently caring for 2 clients, both of which were present during my visit.

At approximately 1:10 PM, LPA initiated a tour of the facility and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. Water temperature in clients' bathrooms measured within allowable range of 105 to 120 degrees F per regulation. LPA observed a supply of clean linens, PPE and extra incontinence supplies available to clients in care.

LPA observed all occupied and vacant client rooms and determined they had the appropriate furnishings as outlined in Title 22 regulations.

Cabinets containing cleaning supplies, knives and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods and a supply of bottled water, as well as emergency supplies and flashlights. In addition, the facility has a back-up battery wall for emergency power.

LPA will return at a later date to inspect resident and staff records, medicine administration and P&I record keeping and administration.

Report was reviewed with administrator whose signature denotes receipt.