Facility Evaluation Report

Licensing Program Analyst, LPA, Noel Wolf Petersen Arrived unannounced to the facility to conduct an annual inspection of the licensed property. LPA met with Administrator Jason Trinidad to explain the purpose of the visit.

A physical inspection was conducted including but not limited to the kitchen, bedrooms, bathrooms, exteriors, common areas, and evacuation route. the facility is clean, the traffic areas are well lit and unobstructed.Kitchen had adequate storage for sharps, medications, and toxics. The facility has adquate storage of food for 2 days perishable and 7 days non perishable foods. Bedrooms and bathrooms have adequate furniture and furnishings. The bathroom hardware is in good repair, water basin temperature is delivered between 105 and 120*F. LPA gave guidance the water heater in the northeast corner of the floor plan should get some calibration. Exteriors and common areas have adequate space for activities. Evacuation route swings freely and latches closed.

Medication was reviewed for 3 clients at random, two clients had a discrepancy with the PRN reason section being filled out. LPA gave guidance to completely fill out. First aid kit has required items, the smoke alarm is functional, fire extinguisher is dated september 2025. Interviewed 2 staff, interviewed 2 clients.

Staff files were reviewed for health screening, background check, first aid/cpr, and continuing/initial training. files were present and up to date. Client files were reviewed for health screening, needs and services plans, updated medical/mental assessments, admission agreement. files are present and up to date. Administrator files: including liability insurance and workers comp, facility license, administrator's certificate, the required posters(ombudsman, personal rights, facility sketch with evacuation route). files are present and up to date.

No citations issued as part of this visit. a copy of the report was read and given to the administrator. exit interview conducted.