Facility Evaluation Report

Unannounced annual visit made out to this facility on 12/12/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person. This LPA requested that they go ahead and notify the facility designated Administrator, Deborah Mensonides, to inform her that CCL was present at this time to conduct the annual visit. Brief interview was conducted with the facility staff person at this time.

It was learned that this facility is also vendorized through Valley Mountain Regional Center (VMRC) to be able to accept and retain (6) Level 2 residents at any given time.

Current census was (6) residents, of which (4), were out of this facility at their respectable day programs at this time with (1) at a doctors appointment and (1) resident was present at this time.

Tour of this facility was conducted alongside the facility staff person.

Dining area, living areas, and all other areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

A tour of the facility kitchen was conducted.

Food storage was reviewed to make sure that this facility maintained the appropriate 2-day perishable and 7-day nonperishable quantities at all times.

Medication cart, located in the restroom, was observed to be locked and made inaccessible to the residents at this time. Policies and procedures were discussed with the facility staff person in regards to handling, dispensing, and proper documentation of the resident medications.

First aid kit, located in the medication cart, was observed to be present and contained all of the required components at this time.

Fire extinguisher, located hanging in the laundry area, was observed to have been annually inspected on 01/04/2022 by the local fire extinguisher company, Jorgensen and Company, and in compliance at this time.

A tour of the facility resident bedrooms was conducted. 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 facility resident restrooms was conducted. Hot water temperatures were taken and measured to

make sure that they were within the allowed range of 105-120 degrees.