Facility Evaluation Report

On 03/16/22 at 9:00 AM. Licensing Program Analyst (LPA) Catherine Lin arrived announced to conduct Pre-licensing Required inspection. LPA met with Administrator, Debra Pickens and explained the purpose of the visit. The facility currently has no clients.

LPA toured facility including but not limited to 2 bedrooms, 1 bathroom, kitchen, common area and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathroom was equipped with non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 68 degrees F and hot water temperature was maintained at 117 degrees F. First-aid kit was observed to be complete. A combination detector of smoke and carbon monoxide was operational. Fire extinguisher was last serviced on 03/07/2022.

Prior to licensure, the following shall be corrected and submitted to CCL by 03/18/2022.

5 out of 7 windows have no screens, 1 window screen was broken and required to be replaced.

One of the night stand drawers doesn't not close properly and required to be repaired.

30-day of PPE supplies is not adequate, facility has no gown, face shield and N95 respiratory. Administrator contacted Regional Center where will provide PPE to facility.

Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.