At 12:45 p.m., the LPA toured the physical plant areas inside and outside with applicants to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Kitchen knives are stored locked and inaccessible in a kitchen cabinet on the right-hand side of the refrigerator. Cleaning supplies are locked inaccessible under the kitchen sink. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean and appeared functional. There is an adequate supply of emergency food and water.

BEDROOMS: There are (5) five bedrooms in the facility; the facility has (4) four private bedrooms for resident use and (1) shared bedroom for resident use there is no staff room, and the facility has a den that is used as office space for staff. All resident rooms have direct access to the outside. Lighting in the rooms appeared adequate. (3) out out of (5) five resident rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. Administrator indicated they would be furnishing the empty rooms immediately.

BATHROOMS: There are (2) two full bathrooms; one bathroom is located in Bedroom #1 and the 2^nd bathroom is located in the main hallway. (2) two of (2) two resident showers are equipped with nonskid surfaces and available nonskid mats.

**Continue on LIC 809-C**

Grab bars were observed in the bathrooms. Hot water temperature measured in bathrooms measured between 123.4 – 123.8 degrees Fahrenheit. Administrator will adjust the hot water temperature slightly to meet regulation requirements.

COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. The facility smoke alarm system is hard wired; the smoke detectors were operable at the time of the visit. There are two (2) fire extinguishers which were fully charged and last serviced on 3/22/2023. There is a functioning telephone on the premises.

Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted on bulletin board. Other required postings are also posted in on bulletin board.

MEDICATIONS: Medications are in a locked cabinet in the den/staff office. A medication refrigerator was located in the same area but did not have a lock. Administrator will install a lock on the medication refrigerator. The first aid supplies and a first aid manual were stored in the medication cabinet. The Administrator was notified to supply the first aid kit with scissors.

FILES: Resident and staff records are stored in in a locked cabinet in the den/staff office.

LAUNDRY: The laundry area is located in a room between the main hallway and den/staff office. Laundry detergent and chemicals are stored inaccessible in a cabinet above the washer and dryer. Extra linens and towels are also kept in a cabinet in the laundry room.

EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with a table and chairs for resident use. There are no bodies of water noted on the premises. There are (3) three storage units in the backyard used for miscellaneous items (2) two of the storage units are locked and inaccessible. (1) one storage unit is only used to hold additional furniture items and is not locked.Tools and chemicals were noted to be unlocked and will need to be locked in a corresponding storage unit. Administrator indicated they would put it away. The back and sides of the house are separated from the front yard by gates at the north and south side passageways, both gates have a single latch however are not self-latching.

**Continued on LIC 809-C**

Administrator will make necessary repairs to ensure doors open and close properly and self-latch. There is no front yard gate or driveway gate. The garage on the property is attached to the home and is accessible through the kitchen which is kept locked. The garage is used for additional storage space of cleaning supplies, tools, personal protective equipment (PPE) and emergency food supplies. There are no other structures on the property.

INFECTION CONTROL: The facility has an area that will be used as a central entry point for symptom screening and sanitation station for staff, residents, and visitors. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19.

Facility is not compliance with Title 22 Regulations at this time. Applicant will be required to complete the following corrections and submit documentation to LPA Elsie Campos within 10 days:

- Documentation of water temperatures meeting Title 22 regulations.

- Photos that rooms have been fully furnished.

- Photos that medication refrigerator lock has been added and that the tools and chemicals in the backyard have been locked away.

- Documentation of outside exit gates have been repaired to self-latch and close properly

Upon receipt of the above items, physical plant will be in compliance with Title 22 regulations. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted and report issued.