Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:45AM. LPA initially met with facility staff. Licensee/Administrator was contacted via telephone and arrived at 10:32AM. Entrance interview conducted.

Beginning at 10:43AM, t he 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 smoke detectors and fire doors were tested at 01:58PM, separate carbon monoxide detectors were tested at 02:00PM. All were functional at the time of the visit. Fire extinguishers were observed to be fully charged and last serviced on 11/16/2023.

KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and cleaning supplies were observed to be locked and properly stored at the time of the visit.

Adjacent to the kitchen is the locked facility garage, which contains a laundry area, locked chemical storage, extra food supply, emergency food and water as well as storage.

BEDROOMS: There are 4 (four) total bedrooms, of which 2 (two) are designated for private resident use and 2 (two) are designated for shared use. Previously, the facility contained a staff bedroom, however Licensee requested conversion of the staff room to a resident room and fire clearance was approved on 07/22/2023. During today's visit, the LPA observed all resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.