Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:03AM. LPA met with facility Administrator Lourdes Ricafort and discussed the reason for today's visit. Entrance interview conducted.

At 09:27PM, LPA, along with 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:

Fire Extinguishers were observed to be fully charged and last serviced on 06/07/2023. Separate carbon monoxide detector and smoke detector were tested at 12:39PM and 12:40PM and functioned properly.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. The garage was observed to be locked and contained extra food, separately stored cleaning supplies and storage for additional items.

The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. Outdoor shed was observed locked. Exit route was observed to be clear and free from hazard.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are for resident use and 1 (one) is designated as a staff room.

RESTROOMS: The LPA observed 2 (two) restrooms in the facility; 1 (one) is a shared resident restroom located in the hallway and the other is a private resident restroom attached to a vacant resident room. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Report Continued on LIC 809-C