Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 12:58PM. LPA initially met with facility staff. Licensee/Administrator was contacted via telephone and arrived at the facility at 01:07PM. Entrance interview conducted.

Beginning at 01:14PM, the LPA, along with Licensee 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:

RESTROOMS: The LPA observed 2 (two) restrooms in the facility; one is a shared restroom and one is a private restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Water temperature was measured in both resident restrooms and measured within the required range.

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 private resident use and 1 (one) is designated as a shared resident room. There is an additional staff rest area off the dining room, which was observed to contain a bed and sliding glass door exit. LPA noted this area is on the facility sketch submitted for the 07/20/2024 fire clearance.

GARAGE: The garage was observed adjacent to the facility kitchen. Garage remains locked. The garage contains laundry area, emergency food and water, as well as supplies and extra food.

KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and