Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual inspection at 11:55AM. The LPA was greeted by staff and informed them of the reason for the visit. Incoming Administrator Melissa Shubin arrived at 12:34PM. Entrance interview conducted.

Beginning at 11:59AM, the LPA and the staff 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:

BEDROOMS: The facility contains 5 (five) bedrooms for resident use. 4 (four) rooms are designated for private use and 1 (one) is a shared room. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway with extra towels and linens.

BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with soap and paper towels. Hot water temperature was measured in both resident restrooms and was within the required range.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. Hardwired combination smoke and carbon monoxide detectors were tested at 04:01PM and were operational at the time of the visit. The LPA observed required postings throughout the common space. The washer and dryer are located in a laundry room next to the medication closet. The laundry room is locked and inaccessible to residents in care.

KITCHEN: Knives and cleaning supplies are stored locked and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable foods and non-perishable food. The fire extinguisher was fully charged and purchased on 11/24/2024.