Facility Evaluation Report

At approximately 10:35 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Administrator Janai Booker. Facility is a Residential Care Facility for the Elderly (RCFE) with zero (0) residents in care.

At approximately 10:45 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 1/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked.

LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is room in the backyard for activities. LPA observed chairs and shade were currently put away against the house. Facility will conduct quarterly disaster drills. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. LPA observed activities for residents such as board games, outdoor activities, and arts and crafts. LPA requested Licensee to inform Community Care Licensing when they admit their first resident.

No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.