Facility Evaluation Report

Licensing Program Analysts (LPAs) Nicole Spencer initiated an announced pre-licensing inspection and COMP III orientation. Administrator Brittany Jones was present during the Pre-Licensing evaluation and LPA explained the purpose of the visit.

An application was submitted to Community Care Licensing Department (CCLD) for an initial application of an Adult Residential Facility (ARF) to serve adults ages 18 to 59. The requested capacity is for four (4) ambulatory residents. Structure: Facility is a single story home consisting of four (4) client bedrooms, an office, two (2) bathrooms, a kitchen, dining area, and living room. The home has a front yard and visitation area, backyard, attached garage, and laundry room with washer and dryer. The front yard is landscaped with grass and has an entrance gate leading to the front entrance. There is also a side gate leading to the backyard. Bedroom Clients: Each client will have their own bedroom. Each bedroom contained a bed, dresser, night stand, chair, and lighting. Bathrooms: Each bathroom has a working toilet, wash basin, and bathtub or shower. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, flat sheet, and blanket and comforter. An adequate supply of linens are stored in the hallway closets. Clients have individual hygiene supplies stored in the hallway closet which include toothbrush, toothpaste, body wash, lotion, comb and brush. Posters and Signage: Emergency Disaster Plan, Labor Information, Personal Rights, and Complaint procedures were posted and readily available for review. Telephones and Fire Extinguishers: One (1) fully charged fire extinguisher was located in the kitchen area. Facility has a working land line telephone. Food Service: Dishes, cups, flatware, and pots are stored in the kitchen cupboards, inspected and in good repair. Knives and other sharp kitchen utensils were in a locked and inaccessible drawer. There was an adequate supply of non-perishables (7 days) and perishable foods (2 days). A variety of foods were observed.

***See LIC 809C for continuation of report.