Facility Evaluation Report

On 5/9/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an announced visit to the facility for purpose of a pre-licensing evaluation. Today’s pre-licensing evaluation was conducted with applicant Tunisia Johnson.

On 4/7/2022 an initial application was received for an Adult Residential Facility to serve Developmentally Disabled Adults for ages 18 to 59 years. The requested capacity is for 6 clients, 6 ambulatory. Facility has a fire clearance for 6 ambulatory clients only.

Structure: Facility is a 3-client bedroom, 1- bathroom, 1 one-story house with a 1 car attached garage and an outdoor shaded area in the back yard. The client bedrooms are spacious and easily accommodate the client's furnishings. There is a back patio which contains a table and 6 chairs as well as an umbrella for shade. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA 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 three bedrooms have two beds, two chairs, overhead lighting, closets and dressers. All drawers comply with the requirement of 8 cubic feet of space. There were no designated staff bedrooms observed.

Bathrooms: Bathroom has working toilets, wash basins and shower/bathtub.

Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen; sheets, pillow cases, hand towels, bath towels and wash clothes where observed stored in each bedroom.