Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:14AM. LPA initially met with facility staff. Licensee/Administrator was contacted via telephone and arrived at 09:50AM. Entrance interview conducted.

Beginning at 09:53AM, the LPA, along with Licensee/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:

Hardwired combination smoke and carbon monoxide detectors were tested at 11:55AM and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and purchased on 02/20/2024.

OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for resident use. All exits and passageways were observed to be free of hazards.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room, dining room, and sitting room furniture was observed to be in good condition. The LPA observed the required postings in the common area. 2 (two) fireplace were observed and were properly screened at the time of the visit.

RESTROOMS: The LPA observed 3 (three) restrooms in the facility; 1 (one) is for shared use and 1 (one) is designated for private resident use and 1 (one) is a half bath used for staff and guests. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in andboth resident restrooms and measured within the required range.

BEDROOMS: The facility consists of 5 (five) resident bedrooms. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.