Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a Required -1 Year inspection and met with Margaret Mroz, Administrator.

LPA toured the facility, which was at a comfortable temperature; all exits were unobstructed. Staff have CPR/First Aid certifications. Fire extinguishers were charged and serviced 03/15/2023. LPA reviewed staff and client files. 2 of 2 client bedrooms were fully furnished per regulation. Cleaning solutions and disinfectants were observed locked. Liquid hand soap and paper towels are available in bathrooms. Facility food supply was within regulation and accessible to clients. Medication was centrally stored and locked. The facility has an in-ground pool located in the backyard, which was inaccessible/blocked with an iron fence and observed locked.

LPA requested the following updated forms to be submitted to Community Care Licensing by 06/19/2023:

· LIC 308 Designation of Facility Responsibility (1 person per form)

· LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents)

· Copy of current Administrator's Certificate

Exit interview conducted with Administrator, whose signature on this document confirms receipt.

***No deficiencies cited during this inspection