Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa (JN) arrived unannounced to conduct a Required 1-year visit of the facility. LPA was welcomed by DSPs Blaylock and Jacinta Ogutu. There are 4 residents at the facility, but only 2 were present at the time of inspection. Co-Administrator Amber Palesi arrived shortly.

The facility has 4 client bedrooms. There is one bathroom for clients and one for staff that were inspected. The hot water temperature in measured 118.9 F. Toxic cleaning supplies are stored in a locked closet located in the office/laundry room. Perishable and nonperishable food supplies were sufficient to Title 22 Regulations of 2 days of perishable and 7 days of nonperishable. Knives and other sharps are kept locked in office drawer. The kitchen and dining area were organized and free of clutter. The facility is well lit with a comfortable temperature of 71 F. The facility was clean and well maintained.

The facility has a locked medication cupboard located in the office. The Facility has a pull station fire alarm with audible notification. Facility has 1 carbon monoxide alarm and one fire extinguisher, which was last inspected on July 12, 2022. Facility has submitted a mitigation program plan that has been approved, on 01/20/2022 and an Infection Control Plan.

LPA Nakagawa is requesting the following documents by 04/10/2023 to RPRO:

LIC308-Designation of Facility Responsibility, LIC400-Affidavit Regarding Client/Resident Cash Resources, Change of Administrator Documents.

No citations were issued during this visit.