Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced at 09:32AM to conduct an annual inspection. LPA was greeted by staff. The LPA communicated with the Administrator/Licensee Cilva Toume via telephone and explained the reason for the visit. Licensee Cilva Toume arrived at 10:12AM. Entrance interview conducted.

Beginning at 10:26AM, the LPA along with the Licensee 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:

BEDROOMS: The facility contains 6 (six) private residents’ bedrooms and 2 (two) staff bedrooms. Every residents’ room has a direct exit to the outdoors. Staff rooms remain locked. All resident rooms were observed to contain appropriate furnishings, linens and lighting.

RESTROOMS: Facility has one common bathroom and private bathrooms in room #1 and #5. Bathroom s are equipped with grab bars and non-skid mats in the shower area for resident use. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in the common resident restroom and measured within the required range after a slight adjustment.

COMMON AREAS: The living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is not in operation and is blocked by the television cabinet and the television. The facility maintained a comfortable temperature throughout the visit. Hardwired smoke and carbon monoxide detectors were tested and were operational. One fire extinguisher was fully charged and purchased on 05/23/2024. The LPA observed required postings by the entrance of the facility.

KITCHEN : Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food.