Facility Evaluation Report

On 06/12/2025 at 11:00 AM, Licensing Program Analyst (LPA) Triel Ellen Lindstrom and Licensing Program Manager (LPM) Lisa Rios arrived at the facility unannounced to conduct a required annual inspection and was greeted by the Designated Facility Administrator (DFA). The LPA and LPM identified themselves and explained the purpose of the visit. The purpose of the visit was to conduct a required annual inspection. The DFA accompanied the LPA on a tour of the physical plant, including inside and outside areas, to ensure that there are no health and safety hazards. The inspection tool was used during this site visit.

This facility is a 2-story residential home. The facility has a capacity of four and currently has two residents in care. The residents occupy the two bedrooms, two bathrooms, and common areas on the bottom floor. The facility has two staff, who occupy the living quarters on the second floor. The facility is vendorized by Valley Mountain Regional Center as a Level 3 facility.

ENTRY ROOM/LAUNDRY: At 11:17 AM, the LPA entered the facility and toured the entry room, which contained the washer and dryer. The LPA observed a fire extinguisher hanging on the wall, which was purchased at Lowes on 4/28/2025.

KITCHEN and DINING ROOM: At 11:23 AM, the LPA toured the kitchen. The kitchen counters, sink, floor, and appliances are clean, operable, and odor- and pest-free. The facility has the required supply of perishable and nonperishable food located in the refrigerator, freezer, and cupboards. Sharp objects are stored in a drawer with a lock, which can be locked if needed. This is not required for the current residents. A small two-person dining table is located in the kitchen and there is a kitchen island with three stools at it. The thermostat is set at 73 degrees Fahrenheit. The facility’s disaster drill logs are located on the side of the refrigerator.