Facility Evaluation Report

At 10:10am, on 04/02/2025, Licensing Program Manager (LPM), Lisa Rios, and Licensing Program Analysts (LPAs) Arielle Pascua and Triel Lindstrom arrived unannounced to this facility to conduct an annual visit. LPAs met with Facility Designated Representative (FDR), Kenroy Anderson and explained the purpose of the visit. The purpose of this visit was to conduct an annual visit.

Current Census was 4. 2 out 4 residents were out at their respective day program.

A brief interview with FDR Anderson was conducted.

This facility is licensed to serve 4 residents at this time. This facility is also vendorized by Valley Mountain Regional Center to served and accept Level 4I residents.

LPA reviewed 4 staff files and 4 resident files. All of which were complete and up to date.

A tour of the facility was conducted. It was observed that 1 residents were sleeping in their respective rooms.

LPA observed a locked centralized stored medication cabinet located in the living room. It was learned that this facility now uses an Electronic Medication Administration Record. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

Fire extinguisher located in the living room was serviced on 07/30/2025. Smoke Detectors and carbon monoxide was observed to be functional and in good repair.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

Kitchen area was toured. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care.