Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:42AM. LPA met with Licensee/Administrator Cilva Toume. Entrance interview conducted.

Beginning at 12:20PM, the LPA, along with Licensee/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 recently serviced. Carbon Monoxide detector was tested at 03:05PM. Smoke detectors were tested at 03:06PM. All were functional at the time of the visit.

BEDROOMS : There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated for resident use 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 two (2) bathrooms for resident use. One (1) is designated for shared resident use and one (1) is a private restroom. 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 shared resident bathroom and measured in compliance with regulation.

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.

KITCHEN : The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Knives are stored in a locked kitchen drawer. Medications are stored in a locked kitchen cabinet.