Facility Evaluation Report

Licensing Program Analysts (LPAs) Jade Jordan, made an announced, and met with the Administrator Jessica Diaz to conduct a Pre-Licensing evaluation on Friday, January 28, 2022, at 11:00 am.

An application was submitted to Community Care Licensing Department (CCLD) on 08/20/2021 for an initial application to serve Individuals for the ages 18-59 years old, . The requested capacity is for Two (2) non-ambulatory clients, one (1) ambulatory clients, a total capacity of three (3). Structure: The facility is a one-story family home in a residential neighborhood. There is a family room, living room, attached garage, laundry room, 2 common bathrooms, (both of which is wheelchair accessible), kitchen, and backyard. Bedroom Residents: There shall be no more than two clients per bedrooms. Bedrooms #1 are for ambulatory clients, Bedroom #2,3 is for non-ambulatory client. Bedrooms are equipped with one bed, nightstand, chair, lamp, and overhead lightning. Bedroom Staff : No bedrooms are used for live in staff. Bathrooms: Two (2) common bathrooms have a working toilet, showers/bathtub with skid mat, and grab bars. Both bathrooms that will accommodate non-ambulatory clients in a wheelchair. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, fitted sheet, blanket and bedspreads. Ample supply of linen is stored in each bedroom. Emergency Phone Numbers, Exit Plan, & Menu: Emergency numbers are posted and readily available for review in living room area. Facility is still waiting on a land line telephone. Two (2) fully charged fire extinguishers are located in hall, and and kitchen, serviced on 12/07/21. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils will be stored, and locked away. Ample food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables.