Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:08AM. LPA met with facility Designee Flordeliza (Baby) Hipolito and explained the reason for today’s visit. Entrance interview conducted.

Beginning at 10:25 AM, the LPA, along with the Facility Designee 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:

BEDROOMS: Resident bedrooms appeared to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 20 (twenty) total bedrooms, all of which were observed during the facility tour; 4 (four) are private resident rooms and 16 (sixteen) are shared resident rooms.

RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. LPA observed sufficient amounts of soap and paper products in each restroom. Water temperature was tested in a sampling of resident restrooms, which was measured at 108.3 degrees Fahrenheit and 108.4 degrees Fahrenheit, 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, common seating area and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be fully charged and serviced on 08/30/2022. Smoke detectors were tested during fire inspection on 01/31/2023 and were functional at that time. During today's visit, at 02:53PM, carbon monoxide detector was tested and was functional at the time of the visit. The temperature was maintained at a