Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 12:15PM. The LPA met with Licensees Teresita and Larry Wayne and discussed the reason for the visit.

The LPA, along with facility Licensee Larry Wayne, 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:

Fire extinguishers were observed to be fully charged, but purchased over 12 months prior to today's visit. During the visit, Licensee purchased new fire extinguishers. Hardwired smoke detectors and separate carbon monoxide detector were tested at 06:10PM and were functional at the time of the visit.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area.

The backyard has a covered outdoor area equipped with furniture for resident use. Licensee indicated the residents do not use the backyard area. There were no bodies of water noted. The back patio did contain items being stored, however no hazardous items were observed and the passageways were clear from obstructions.

The laundry room was observed to be locked and contained cleaning chemical storage, as well as storage for additional items. The garage was observed locked.

KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All sharp objects were observed to be locked and properly stored at Report Continued on LIC 809-C