Facility Evaluation Report

Licensing Program Analyst (LPA) Martha Arroyo conducted a Subsequent Pre-Licensing Visit to the facility today. The reason for this visit is to update the fire clearance approved after the pre-licensing visit initiated on 08/06/2024. LPA met with Applicant Representative, Sara Jackson as this is a change of ownership application from Sally’s Residential Care Home, Inc. #565800706 to Sally Residential Care Home 3 #565850406. The applicant has obtained fire clearance for a total capacity of six (6) residents, all of which may be bedridden in bedrooms #1 - #4 and bedroom #5 approved for ambulatory only. The facility has a dementia program in place.

During today’s visit, the LPA toured the physical plant areas to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations and conducted a medication review. The following was observed:

The LPA observed two (2) resident restrooms, which were clean and sanitary and in operating condition with non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The LPA observed five (5) resident bedrooms; four (4) bedrooms are designated as single occupancy; and one (1) bedroom is designated as double occupancy. All resident bedrooms were observed to be furnished appropriately and had sufficient lighting. Fire clearance also approved for staff bedroom on premises. The LPA inspected the kitchen/food service area. The facility has a sufficient supply of perishable and non-perishable food. All indoor and outdoor passageways were free from obstructions in case of an emergency. No bodies of water noted at the time of the visit.