Facility Evaluation Report

On 08/12/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. Facility staff contacted Administrator, Jessica Mata via telephone. Administrator arrived a short time later. LPA met with Administrator, Jessica Mata and Client Care Coordinator, Jaylyn Johnson .

LPA conducted a tour of the facility. During the inspection the facility appeared clean and odor free and at a comfortable temperature. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms appeared clean and had required furnishings and adequate lighting. Residents bathrooms appeared clean, water temperature measured at 109.9 degrees F. Facility kitchen appeared to be clean and safe for food preparation. LPA observed 2-day supply of perishable foods and a 7-day supply of non-perishable food.

Exterior tour conducted, all exits open and free of obstructions on today’s visit. Fire extinguisher is current with a service date of 12/01/2023. Smoke detectors and carbon monoxide detector observed to operational. Last fire drill conducted on 08/07/2024. Cleaning supplies observed to be locked in a cabinet under the kitchen sink. LPA reviewed client and staff files. Medications observed to be locked and administered as prescribed.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Jessica Mata, whose signature on this form confirms receipt of this document.

The following updated forms are to be submitted to the CCL office by 08/26/2024:

LIC308, LIC500, LIC9020, LIC400, LIC402, and LIC610D