Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:44AM. LPA was greeted by staff. Facility Designee Arnida Obtinalla was available shortly after the LPA's arrival. Entrance interview conducted.

Beginning at 09:55AM, the LPA, along with Facility Designee 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:

BEDROOMS : There are five (5) bedrooms in the facility; four (4) bedrooms are designated for resident use, including two (2) shared rooms, and two (2) private rooms. There is one (1) staff room, which was observed to be locked. All four (4) resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

BATHROOMS : There are two (2) bathrooms for resident use, one (1) of which is a shared resident restroom located in the hallway and one (1) is a private resident restroom. Restrooms were observed to be equipped with slip-resistant surfaces. Grab bars were observed in the bathrooms. The water temperature was measured in the shared resident bathroom to be 115.5 degrees Fahrenheit, which is within the required range.

KITCHEN : The LPA observed the kitchen/dining area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food and emergency water. The LPA observed one designated cabinet where knives and sharps are stored Report Continued on LIC 809-C