Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek conducted a Required 1-year annual visit to this facility. Upon arrival LPA met with Administrator Ramona (Mona) Keeton. Facility is fire cleared for two (2) Ambulatory clients. Facility is vendored by Tri-Counties Regional Center as a Level 3 home.

LPA Dulek and Administrator conducted a tour of the facility at 11:47AM and the following was observed:

Smoke and carbon monoxide (dual) detectors tested at 12:08PM and function properly. The fire extinguisher was fully charged. Emergency/Disaster record and all other required postings were observed on the wall near the entrance.

Kitchen: The kitchen is currently under construction, due to a previous water leak in the facility. However, kitchen appeared clean and the appliances and fixtures functional. Knives and sharps are locked. LPA observed a sufficient amount of two (2) day perishable food supply and seven (7) day non-perishable food supply.

Bedrooms: There are four (4) total bedrooms; 2 (two) bedrooms designated for clients' use and two (2) bedrooms for staff/family. All bedrooms were properly furnished and had appropriate bedding and linens.

Bathrooms: There are two bathrooms designated for clients' use. One is under construction, the second bathroom was clean, properly supplied and had functional fixtures.

Common Areas : These included the living room, family room, and dining areas. The common areas were clean and properly furnished. Properly labeled medications were locked in a closet in the foyer.

Surrounding Grounds : All passageways were free of obstruction. LPA noted that the side exit gate has a lock, but it was unlocked during today’s visit. Report Continued on LIC 809-C.