Facility Evaluation Report

On 4/12/23, Licensing Program Analyst (LPA), Martessa Brown conducted a continuation visit to the facility for purpose of a pre-licensing evaluation. LPA met with Tina Duff-Licensee. An application was submitted to CCLD on 4/18/22 for Initial license for an Adult Residential Facility to serve Developmentally Disabled Adults for ages 18 to 59 years. The requested capacity is for 2 ambulatory clients.

Facility is 2 bedrooms and 1 bathroom, single story house with a garage. The client bedrooms are spacious and will easily accommodate the client's furnishings. 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 2 ambulatory clients. Bedroom #1-2 each have one bed, one chair, one-night stand, one lamp in addition to overhead lighting. There is one dresser in each bedrooms #1-2 which comply with the requirement of 8 cubic feet of space. There were no designated staff bedrooms observed. Bathroom: Bathrooms #1 has 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.

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. 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. Food supply inadequate but applicant will increase inventory; stored in kitchen refrigerator and cabinets and consists of the following: A variety of Fresh and Canned fruit, vegetable and meat food items.