Facility Evaluation Report

Licensing Program Analysts (LPA), Martessa Brown, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to CCLD on 1/11/22, for Initial license for an Adult Residential Facility to serve Developmentally Disabled Adults for ages 18 to 59 years. The requested capacity is for 4 ambulatory clients.

Facility is a 4 bedroom, 2 bathrooms, single story house. The client bedrooms are spacious and will easily accommodate the client's furnishings. There is a back yard with a covered patio for shade. The patio contained 1 table and 4 chairs. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPAs did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Bedrooms Residents: All Bedrooms are for 4 ambulatory clients. Bedroom #1, #2, #3 and #4 each have one bed, one chair, one-night stand, one lamp in addition to overhead lighting. There is one dresser with drawers in Bedrooms which comply with the requirement of 8 cubic feet of space. There were no designated staff bedrooms observed. Bathrooms: Bathrooms #1 and #2 have a working toilet, wash basins and showers. LPA observed adequate lighting in hallway leading to bathrooms #2. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet.

Emergency Phone Numbers, Exit Plan & Menu: The telephone system has a land line. Emergency Disaster Plan and "See something, Say something Let Us Know" posted & readily available for review on the wall between the living room and kitchen. Menu available for review located in a locked kitchen cabinet opposite the refrigerator. Fire Extinguisher mounted on the kitchen wall opposite postings. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet located in the kitchen area.