Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 12:12 PM. The LPA met with facility designee Tina Marie Martinez. Licensee was unavailable during today's visit. Entrance interview conducted.

The LPA, along with facility designee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are designated for resident use and 1 (one) is designated as a staff room. The staff room was observed to be locked at the time of the visit.

RESTROOMS: The LPA observed 3 (three) restrooms in the facility; one is a shared restroom, one is a private restroom and one is designated for staff use. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in the common resident restroom and measured 114.2 degrees Fahrenheit, which is within the required range.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room, family room, and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. Fire extinguisher was observed to be fully charged and last serviced on 05/23/2022. During today's visit a new fire extinguisher was purchased and delivered to the facility. Smoke detector and carbon monoxide detectors were tested at 02:54PM and were functional at the time of the visit. Report Continued on LIC 809-C