Facility Evaluation Report

Licensing Program Analysts (LPAs) Kelly Dulek and Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 11:01AM. LPAs met with Licensee/Administrator Jennifer Shaffer. Entrance interview conducted.

Beginning at 11:15AM, the LPAs, along with Licensee/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 recently serviced on 04/03/2024. Hardwired combination smoke and carbon monoxide detectors and fire door were tested at 12:45PM and all were functional at the time of the visit. No fire clearance concerns were observed.

BEDROOMS : There are 5 (five) total bedrooms in the facility; 2 (two) are designated as shared rooms, 2 (two) are designated as private resident rooms and 1 (one) is utilized as a staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Room #1, which belongs to Resident #1 (R1) was observed to have full bed rails. Room #4, belonging to Resident #2 (R2) contained unsecured Advil in the resident's drawer. Staff room was observed to be locked.

BATHROOMS : There are 2 (two) bathrooms for resident use. 1 (one) is designated for shared resident use and the other 1 (one) is a private resident restroom. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in both resident bathrooms and measured within the required range.

COMMON AREAS : This includes the living room and dining room areas. LPAs observed common area to be clean and properly furnished at the time of the visit. A fireplace was observed in the living room and was inaccessible to residents in care. Exit doors contain alarms and were functional at the time of the visit.

OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs