Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 08:40AM. LPA initially met with facility staff. Administrator Evelyn Rayas was contacted and arrived shortly after the visit began. Entrance interview conducted.

Beginning at 09:10AM, the LPA, along with Administrator 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:

Fire extinguishers are fully charged and last serviced on 05/19/2023. Hard wired combination smoke detectors and fire doors were tested at 11:03AM, separate carbon monoxide detector was tested at 11:05AM and all were functional at the time of the visit. No fire clearance concerns were observed.

KITCHEN : The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Medications and sharps are locked in a separate kitchen cabinet. Water was tested in the kitchen sink and measured in the appropriate range.

COMMON AREAS : This includes the living room, family room, and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. An adequately screened fireplace was noted in the living room.

BATHROOMS : There are three (3) bathrooms for resident use. One (1) shared half bathroom was observed Report Continued on LIC 809-C