Facility Evaluation Report

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property at 1:00pm on 1/20/2023 and met with applicant representative Loretta Tiede. The applicant has obtained fire clearance for a total capacity of five (5) non-ambulatory residents, and one (1) bedridden resident in bedroom #5 for a total capacity of six (6) residents.

LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 1:26pm, all hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. LPA observed two (2) fire extinguishers to be fully charged on 10/11/2022.

There are six (6) single occupancy bedrooms for resident use. Five (5) bedrooms are inside the house while bedroom #6 is located outside in the backhouse. There will be no-live in staff. Facility will have 24-hour wake staff. Each bedroom is equipped with clean mattresses, pillows, and bedding. There is sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. The facility has four (4) bathroom for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms has sufficient paper products. Night-lights were present in the main hallway. Hot water measured at 109.4 degrees Fahrenheit at 1:22pm.

LPA toured the kitchen area at 1:29pm. The facility has at least seven (7) day supply of non-perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives are stored in a locked drawer next to the oven. The kitchen has a sufficient supply of plates, cups, cook ware and utensils. Kitchen hot water measured at 114.8 degrees Fahrenheit at 1:41pm.

The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. Enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies for future residents.