Facility Evaluation Report

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property. LPA met with Applicant Representative Sara Jackson as this is a change of ownership application from Sally’s Residential Care Home #565800494 to Sally Residential Care Home #565850407. The applicant has obtained fire clearance for a total capacity of six (6) residents, all of which may be bedridden in bedrooms #1 - #4. The facility has a dementia program in place.

LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The smoke alarms and carbon monoxide detectors were tested and function properly. LPA observed one (1) fire extinguisher to be new and fully charged on 08/04/2024.

There is two (2) double occupancy bedrooms and two (2) single occupancy bedrooms for resident use and one (1) staff room. Each bedroom is equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a cabinet in the hallway with a sufficient supply of linens, including blankets, bath towels and wash cloths. There is a locked closet with the resident’s personal hygiene items. The facility has two (2) bathrooms for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms have sufficient paper products. Hot water temperature was measured in both bathrooms, and they measured between 105- and 120 degrees Fahrenheit. LPA observed trash cans with tight fitting lids at the time of the visit.

LPA toured the kitchen area at 10:10 a.m. The facility has at least seven (7) day supply of non-perishable food and two (2) days perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives and sharps were observed in a locked drawer next to the gas range. The kitchen has a sufficient supply of plates, cups, cookware, and utensils.