Routine inspection·June 20, 2023

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Annual inspection focused on domains within the Compliance and Regulatory Enforcement (Care) Tools. LPA met with Administrator Rebecca Sinclair and the purpose of the visit was discussed. Structure/Physical Plant: The facility is part of a single story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, (3) resident rooms, (2) bathrooms for residents; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for resident use. A connected garage inaccessible to residents for storage, Laundry, office/resting space for staff. The residence is equipped with central air and heating. Adequate accommodations observed throughout facility. Facility observed to be clean of obstruction and debris. Bedrooms #1-#3 for resident use are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, beds for each resident, and closet space. Bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Medications are stored, locked and inaccessible to residents in care. Required linen/supplies observed. Facility has a working phone landline. Fire Extinguisher observed fully charged and up to date. The hot water temperature was measured within title 22 regulations. The food supply in the kitchen and pantry has at least two days perishable and seven days non perishable food. Smoke detectors and also carbon monoxide detectors observed, all detectors tested and operational. All appliances observed operational. Toxins and sharps observed to be Locked/stored for staff use only. POSTINGS: All necessary postings were observed to be posted in appropriate places. A current Plan of Operations and Disaster plan is maintained at the facility. RECORD REVIEW: LPA reviewed five (5) resident files, five (5) residents medications, and three (3) staff files. Inspection tool completed and no deficiencies cited on todays visit. Exit interview conducted and a copy of this report was provided.