Facility Evaluation Report

At approximately 09:15AM, Licensing Program Analyst (LPA) Ali Deniz made an unannounced annual inspection of this licensed adult care facility. LPA met with facility Administrator Barrett Adams. Licensee Olukemi Kuku arrived about an hour later. Administrator Barrett Adams weren’t present during this inspection. There is a total of 2 residents at facility, 1 of them was attending a day program

Facility is a 1-story building with 4 Resident bedrooms, 1 staff bedroom, and common spaces.

At approximately 10:45AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Staff was in the process of cleaning up the resident rooms at the time of this inspection. Toxins are stored in a locked housekeeping closet in the hallway. Water temperature measured within regulation between 105- and 120-degrees F at faucets accessible to residents. During the walk LPA/Licensee observed garbage bins in the resident shared bathroom did not have any cover or lid on them (Technical Advisory given). Fire extinguishers were inspected and charged on 03/09/2025. Carbon Monoxide and smoke detectors were present and operational. There was enough lighting in all common areas, resident rooms, and hallways.

During the medication review LPA observed medication was centrally stored and locked, however the medication records or log weren't filled for each medication on MAR log (See LIC809-D page).

At approximately 12:10PM, LPA reviewed 2 resident records and found to be in order and contained current and signed admission agreements and physician's orders on file.