Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced at 09:49AM to conduct an annual inspection. LPA initially met with facility staff. Administrator & Facility Designee were contacted via telephone. Designee Connie Roush arrived at 10:00AM, Administrator arrived shortly thereafter. Entrance interview conducted.

Beginning at 10:06AM, the LPA 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 extinguisher was observed to be fully charged and purchased 01/19/2024. Hardwired combination smoke and carbon monoxide detectors and fire door were tested at 01:02PM. Fire door did not close properly during test. LPA advised that the fire door shall remain closed at all times until the latch is repaired. All other systems were functional at the time of the visit.

KITCHEN : Kitchen knives are stored locked and inaccessible to residents in care. The supply of perishable and nonperishable food and emergency food and water supply is adequate. Appliances in the kitchen were clean and appeared functional.

BEDROOMS : There are (6) six bedrooms in the facility; the facility has 6 (six) private bedrooms for resident use. Lighting in the rooms appeared adequate. All resident rooms contained the appropriate furnishings and linens.

BATHROOMS : There are (2) two full bathrooms in the hallways. There are (1) private bathroom for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature measured at 139.4 degrees Fahrenheit at 10:14AM in the bathroom near bedroom #1. Hot water temperature measured at 135.3 degrees Fahrenheit at 10:23AM in the hallway bathroom. Hot water was not measured in the private resident restroom.