Facility Evaluation Report

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required

annual visit at 10:15 a.m. When the LPA arrived, there was one staff and four residents present. The LPA was greeted by a caregiver staff 1 (S1) and informed them of the reason for the visit. Back-up Administrator Mae Davis arrived shortly after S1 called. The back-up administrator works at the licensee's other facilities.

At 10:18 a.m. LPA conducted a tour of the facility and conducted interviews during the physical plant tour.

The facility is a single-story residence that consists of four (4) resident bedrooms and two (2) bathrooms.

There is one (1) additional bedroom for staff use. The fire extinguisher was last serviced on 9/15/2023 and appeared fully charged. The smoke and carbon monoxide detectors were tested and functioned properly. LPA observed required postings near the entry.

Kitchen : The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA

observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked drawer to the right of the stove and cleaning supplies are stored in a locked cabinet under the sink. LPA observed the cabinet storing cleaning supplies was unlocked and unsupervised.

Bedrooms: The resident bedrooms were properly furnished with adequate lighting, and clean bedding.

Bathrooms: The LPA observed one private resident bathroom, one bathroom used by staff, and one bathroom used by the three other residents. All bathrooms were clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats. Residents have sufficient amounts of supplies for

personal hygiene. The hot water was measured at 112.5*F in the private bathroom and 114.9*F in the other resident bathroom which is within the required limit of 105-120 degrees Fahrenheit. LPA observed in the staff bathroom there were cleaning supplies such as bleach stored in an unlocked cabinet under the sink.