Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived unannounced to conduct a required annual visit. The LPA initially met with facility staff. Administrator Dylan Hull was contacted via telephone and arrived at 11:20AM. LPA explained the reason for the visit. Entrance interview conducted.

Beginning at 11:30AM, the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

Fire extinguisher is fully charged and purchased on 05/15/2023. Hardwired combination smoke/carbon monoxide detectors and fire doors were tested at 01:48 PM and were functional. A copy of the current liability insurance was obtained during today's visit.

COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. An non-functional fireplace was noted in the living room.

BEDROOMS : There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private resident rooms and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

BATHROOMS : There are three (3) bathrooms. Two (2) are designated for resident use and one (1) is a staff/guest restroom. Resident restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in both resident bathrooms and measured within the required range.