Facility Evaluation Report

At approximately 10:55AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required Visit and met with Staff Member/Designated Representative, Abby Adkins. Licensee, Nikiyah Jones, arrived during visit at approximately 11:30AM. Facility is a Residential Care Facility for the Elderly (RCFE) and serves residents with Dementia and has a plan of operation for dementia care and programming on file. Facility is a single story building and has an approved fire clearance and capacity for 4 non-ambulatory residents of which 1 can be bedridden. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were currently 3 residents in care and 1 staff member on-site.

LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Staff Member and Licensee. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Hot water temperatures for all facility sinks were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility fire extinguishers were last inspected September 2025. Smoke and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted June 2026. Facility's emergency disaster plan was last reviewed and updated 2025. Facility has an adequate supply of emergency water accessible in the event they needed to shelter in place for 72 hours.

LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized and thorough.

Staff files had current First Aid and CPR certification. Resident files had updated assessments and appraisals. LPA discussed with Licensee on ensuring that resident appraisals address behavioral expressions if they have been identified in Continued on LIC809C