Facility Evaluation Report

04/17/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There is currently 1 client in care. Facility approved/cleared for 4 ambulatory.

At approximately 10:00 AM, LPA and Administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated.

All rooms were furnished per regulation. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to clients in care were measured at 114.9 and 114.3 within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 07/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to clients were located in the staff room and were found to be secured. Client does not take medication. Cash resources were reviewed. Facilities last fire/emergency drill was conduced 03/2025.

LPA conducted a review of 1 client record. All records had the required documentation. LPA conducted review of 2 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file.

No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/18/2025:

LIC400- Affidavit Regarding Client/Resident Cash Resources

Exit interview conducted with Administrator and a copy of this report was provided .