Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 12:33PM. LPA initially met with facility staff. Facility Designee was contacted via telephone and arrived at the facility at 12:53PM. Entrance interview conducted.

Beginning at 01:08PM, the LPA, along with Facility Designee and facility staff 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 02:47PM and were functional at the time of the visit. Fire extinguishers were observed to be fully charged and last serviced on 09/15/2023.

BEDROOMS: There are 5 (five) total bedrooms, of which 2 (two) are designated as private resident rooms, 2 (two) for shared resident use, and 1 (one) staff room. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

RESTROOMS: The LPA observed 2 (two) restrooms in the facility. 1 (one) is for shared use and 1 (one) is designated as a private restroom. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in the shared resident restroom and measured within the required range.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed to be adequately screened.

KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of