Facility Evaluation Report

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Jessica Mata. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Administrator.

A tour of the facility was conducted with the Administrator. The residence was set at 73 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 4 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Facility currently does not have any residents residing in the facility. Hot water temperature was measured 112.4 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked drawer. Medications were stored in a locked Medication closet. Cleaning supplies were in a locked cabinet in kitchen and a cabinet in the garage. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 12/03/18.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents.

Administrator file was reviewed with current first aid and CPR.

An exit interview was conducted with the Administrator and a copy of this report was provided.