Facility Evaluation Report

On 3/15/2022 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 Ava Brown.

On 12/10/2021 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 5 clients, 4 non-ambulatory, 1 ambulatory. Facility has a fire clearance for 4 non-ambulatory clients and 1 non-ambulatory client only.

Structure: Facility is a 3-client bedroom, 4- bathroom, 1 office, one-story house with a 2-car attached garage and outdoor covered porch in the front yard. The client bedrooms are spacious and easily accommodate the client's furnishings. There is a back yard. chairs. 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: Two bedrooms are for 4 non-ambulatory clients and one bedroom is for an ambulatory client. Two have two beds, two chairs, overhead lighting, closets and dressers. One has one bed, one chair, 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: Bathrooms have 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.