Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:15AM. LPA initially met with facility staff. Licensee was contacted via telephone and arrived at the facility at 10:36AM. Entrance interview conducted.

Beginning at 10:37AM, the LPA, along with Licensee 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:

Hardwired combination smoke and carbon monoxide detectors were tested at 12:51PM and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and purchased on 10/24/2025.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 4 (four) total bedrooms for resident use; 2 (two) are shared rooms and two (2) are private rooms.

RESTROOMS: The LPA observed two (2) restrooms in the facility. One (1) is for resident use and one (1) is designated for staff use. Resident restroom was observed to be clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Water temperature was measured in the resident restroom at 10:45AM and measured at 137.5 degrees Fahrenheit.

KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Adjacent to the kitchen is a locked garage. The garage was observed and contained the laundry area, as well as emergency food supply and water, and storage.