Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two staff and four residents present. The Assistant Administrator Karina Antig was contacted over the phone and arrived shortly after the visit began. Entrance interview conducted.

At 11:15AM, the LPA, along with Assistant Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

LPA noted the facility to be under construction currently. Notification was sent to the Regional Office (RO) on 05/14/2024 indicating 1 bathroom would be renovated and kitchen flooring replaced. Notification also indicated no major construction required and that the scheduled time frame was 05/13/2024 to 05/25/2024. No extension or change of scope of work was received at the RO as of today's date. LPA discussed with Assistant Administrator sending an updated notification letter, as well as ensuring all required building permits are obtained.

BEDROOMS: Typically, there are 4 (four) designated resident rooms and 1 (one) staff room inside the locked garage area, as well as an upstairs area solely dedicated to staff use. At this time, 3 (three) resident rooms are being utilized for resident sleeping use and a vacant resident room is being utilized as a shared common space. LPA observed the 3 (three) resident rooms to contain appropriate linens and furnishings. However, exit doors in all 3 (three) rooms were blocked with storage items, and at least 1 (one) of the doors was observed to be dead bolted shut at the time of the visit.

RESTROOMS: The facility contains 2 (two) shared resident restrooms and 1 (one) staff restroom upstairs. The bathrooms were sufficiently stocked with supplies and paper towels. 1 (one) resident restroom was locked and under construction. The hot water temperature was measured in the common hallway restroom at 129.4 degrees Fahrenheit at 11:28AM. Report Continued on LIC 809-C