Facility Evaluation Report

An unannounced Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Program Director (PD) Pam Chin. LPA introduced self, stated purpose of visit & was allowed to proceed with visit.

Physical plant toured. Program in single room. Room sufficiently furnished with adequate lighting. Bathroom, kitchen/food storage area & activity room observed to appear clean with no unpleasant odors. Program has outside area. Smoke detectors operational. Hot water available. Interior & exterior passageways clear of obstructions.

Records review to be conducted at a later date.

Exit interview conducted with PD. Report reported.