Facility Evaluation Report

Unannounced annual visit made out to this facility on 11/03/2021 by LPA Charlie Yang to conduct an annual inspection. This LPA was met by the facility personnel who was requested, by this LPA, to contact the facility designated Administrator, Maria Denton, to inform her that CCL was present at this time. The facility designated Administrator arrived shortly thereafter to this facility.

This facility is licensed to accept and retain up to (6) residents at any given time. This facility is not vendorized, through Valley Mountain Regional Center, at this time.

Medication cart, located in living area , was reviewed. Policies and procedures surrounding medications was discussed with the facility designated Administrator. First aid kit was observed to be present and contained all of the required components at this time.

Kitchen area was toured. Cabinets and drawers were reviewed to make sure that there was a sufficient amount of flatware, dinnerware, and items for resident use.

Food storage units were reviewed to make sure that there was a sufficient supply of 2-day perishable and 7-day nonperishable quantities at all times.

Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.

A tour of the resident rooms was conducted. Resident bedroom furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

A tour of the resident restrooms was conducted. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees.

Fire extinguisher, located in the hallway, was reviewed and observed to have been annually inspected on 12/04/2019 by the local fire extinguisher company.

Linen closet, located in hallway, was reviewed and observed to contain a sufficient amount of linens to meet