Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct an annual visit. LPA, along with Tri-Counties Regional Center Quality Assurance Specialist (QA) Liz Aced-Arnett arrived at 09:40AM and initially met with facility staff. Administrator was contacted and arrived at the facility at approximately 10:10AM. Entrance interview conducted.

Beginning at 09:45AM, the LPA, QA, along with facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

The facility is vendored through Tri-Counties Regional Center as a Level 3 home. Fire extinguishers are fully charged and last serviced on 07/15/2023. Hardwired combination smoke detectors were tested at 11:46AM and were functional at the time of the visit. No fire clearance concerns were observed.

Bedrooms: There are 4 total bedrooms in the facility. All 4 are private client bedrooms. All 4 client bedrooms were observed and appeared clean, with appropriate linens and furnishings.

Bathrooms: LPA observed all 2 and 1/2 bathrooms were clean, properly supplied and had functional fixtures. LPA observed all bathrooms to have non-skid mats. Clients have sufficient amounts of supplies for personal hygiene . At 09:48AM, Clorox disinfecting wipes and Clean Shower were observed in an unlocked cabinet under the sink in the private restroom for Room #2. Water temperature was measured in client restrooms and measured within the required range.

Common Areas : These included the dining area and living room. The common areas were checked for cleanliness good condition. At the time of the visit, walls, flooring, and furniture were observed to be in good