Facility Evaluation Report

At approximately 9:40 AM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Administrator Jean Rice arrived at approximately 10:00 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with two (2) Hospice residents currently in care, and is approved for all non-ambulatory residents.

At approximately 10:10 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 12/25. Smoke and Carbon Monoxide detectors were tested and operation during inspection. Water temperature measured 105.2 degrees F, which is 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 all the appropriate furnishings as outlined in Title 22 regulations are available. 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 a shaded seating area in the backyard with outdoor space for activities. LPA observed one (1) locked sheds in the backyard which is used as an additional staff room. Facility has an internet access device and internet available to residents in care, and the phone was observed operational during today's inspection.