Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:05AM. The LPA was greeted by staff, Facility Designee Karina Antig arrived shortly thereafter and LPA informed them of the reason for the visit.

Beginning at 11:40AM, the LPA and Facility Designee 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:

Smoke detectors and carbon monoxide detector were tested at 02:26PM and were operational at the time of the visit. The two (2) fire extinguishers were fully charged and last serviced 05/14/2024. Auditory alarms on exit doors were observed to be functional at this time.

BEDROOMS: There are 6 (six) designated resident rooms and 2 (two) staff rooms. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are kept in a hallway closet. LPA discussed with Facility Designee that the current facility sketch includes only 1 (one) staff room and 5 (five) resident bedrooms. Designee stated that all documents were submitted to the Regional Office to request inspection for the additional resident bedroom. LPA will follow up with Facility Designee related this change.

BATHROOMS: The resident 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 and available hygiene products. The hot water temperature in bathrooms initially measured slightly low, however water temperature was adjusted and measured within the required range prior to the end of the visit.

KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Continued on LIC 809-C