Facility Evaluation Report

On 08/06/24 at 9:30AM. Licensing Program Analyst (LPA) Carol Fowler arrived announced to conduct a pre-licensing inspection. LPA met with Administrator/Applicant (ADM) and explained the purpose of the visit. ADM has a current administrator certificate # 6012867735 which expires 06/07/25. Fire clearance was granted on 04/12/24 for 4 ambulatory clients. Facility currently has no clients.

LPA toured the facility with ADM including but not limited to the clients' bedrooms, common areas, kitchen, and outdoor area. Facility has adequate lighting. Indoor and outdoor passageways were observed free of obstruction. LPA observed hot water temperature at 120 degrees F. LPA observed Towels, sheets, activity supplies and hygiene products were observed available. The facility has 2 full and 1 half bathrooms. LPA observed the shower area has non-skid floor tiles. There are activity materials observed in the living room. Facility has flashlights available for emergency use. LPA observed sufficient emergency supplies stored inside the garage. There is sufficient lighting throughout facility. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was observed fully charged. Proper hand-washing signs, Emergency/Disaster plans/contact information, personal rights were observed posted in common areas.

LPA observed no deficiencies during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.