Facility Evaluation Report

At approximately 11:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver (CG) Marcia Waite. Caring Hands at Cloverdale is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, six (6) of whom may be bedridden. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were two (2) residents in care and one (1) staff members on-site.

At approximately 12:05 PM, LPA toured the facility. All exits were clear and unobstructed. The facility's one (1) fire extinguisher was last serviced and tagged on 10/21/2025. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. 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. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational.

LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date.

No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to CG Waite. Signature on form confirms receipt of documents.