Facility Evaluation Report

On 02/15/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Kristin Ennis # 6056767735 Expiration 07/23/24.

LPA conducted a tour of the facility, inside and out. Facility temperature was 69 degrees F. There were 2 residents in care at the time of visit, 2 residents were attending day program and arrived later. Facility is a 4 bedroom 3 bathroom home. Private resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 111 degrees F. Trash can with lid and hand washing postings were observed. Internet devices and a working phone line were observed to be available for residents in care. A supply of extra linen's and towels were observed in the Hallway.

Carbon monoxide and smoke detectors were tested and observed to be operational. Carbon Monoxide detectors are located in the both common hallways and living room. A State Fire Marshall approved automatic fire sprinkler system was observed to be operational. Fire Extinguisher was observed with a service date of 02/09/24. The frame of the fire door inside the east hallway is bent. First aid kit was observed to be adequate.

Cleaning supplies were observed to be in a locked cabinet in the garage. The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed for residents in care. This is a delayed egress home and gates were found to be operational. Quarterly Earthquake & Fire Drill logs were observed for staff 01/05/24. (Continued on 809-C)