Facility Evaluation Report

Licensing Program Analysts (LPAs, Martessa conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to CCLD on 7/29/22, for a license Adult Residential Facility to serve Developmentally Disabled Adults for ages 18 to 59 years. The requested capacity is for 4 clients, 2 non-ambulatory.

Facility is a 4-bedroom, 2-bathroom, single story house with a 2-car attached garage. Bedroom 4 will be used as an office. 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. LPA did not observe any hazards. Bedrooms Residents: Bedroom #1, #2 and #3 each have one bed, one chair, one-night stand, one lamp in addition to overhead lighting. There is one dresser with two drawers in Bedrooms #1, #2 and #3 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.

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. Smoke Detectors: 4 smoke detectors are battery and electric operated & working. Carbon monoxide detector located and mounted in the hallway is operational. Appliances: Stove burners, oven, microwave, washer, and dryer working.