Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios conducted an announced Prelicensing visit to complete Component III orientation. This is a new application for and Adult Residential Facility (ARF). LPA met with the applicant Bruce Molock E. JR. Fire clearance inspection was approved on 03/15/24 with the approved capacity for four (4) ambulatory clients. This is a (4) bedroom two (2) bathroom, single story home.

A tour of the physical plant inside and out was conducted with Bruce Molock E. JR at approximately 9:00 a.m.

Common Areas: These included dining area and living area. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and furniture was in good repair. In the living area LPA observed a telephone, board games and sufficient space for activities. Dining table and couches sit the capacity of the facility. The facility was kept at a comfortable temperature.

Bedrooms: LPA inspected three (3) client bedrooms. One (1) bedroom is shared and has it's own private bathroom. LPA observed bedrooms to be properly furnished and had adequate lighting. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress covers, and blankets.

Bathrooms: LPA observed all bathrooms to be clean, properly supplied with toilet paper, hand soup, and paper towels. LPA observed bathrooms had functional fixtures. Hot water temperature read 120 degrees Fahrenheit within regulation.

Smoke detectors and Carbon Monoxide detectors are interconnected and through out the facility. Applicant tested detectors at 9:30 a.m. and they were observed to be functioning properly. One (1) Fire extinguisher was observed by the kitchen, fully charged with purchase date 03/11/24. (continued to LIC 809-C)