Facility Evaluation Report

Licensing Program Analyst (LPA) LaQueena Lacy arrived to the facility at 10:34am to conduct a One (1) year Required Annual visit. LPA meet with staff Benedict Gomez and explained the purpose of this visit. The facility has one main entrance being used, the PPE screening station is located at the entrance of the facility with sufficient PPE readily accessible, handsanitizer, gloves, mask, and sign in sheet at the time of visit. The facility is a single story seven (07) bedrooms in which is designated as live in staff, two (02) bath with a detached garage. It is licensed for a capacity of six (06) ambulatory clients.

Kitchen: At 10:52am the kitchen was observed to be clean and an adequate supply of perishables and

non-perishable food located in the refrigerator, freezer, and pantry. Sharps were observed to be stored in the kitchen cabinet which was observed to be locked and inaccessible to clients. At 11:37am the fire extinguisher observed to be stored on the wall in the kitchen with a service tag dated 10/28/2022. (02) first aid kit was observed to be stored in a cabinet in the kitchen. The emergency food (02) four (04) person kit is located in the pantry

Bedrooms: At 11:06am LPA observed (07) bedrooms to be appropriately furnished with sufficient lighting. All bedrooms observed to be neat and clear from obstruction. LPA observed appropriate bed linen and comforters on all beds. All bedrooms observed for single occupancy. Second refrigerator located in the designated staff room.

Bathrooms: At 11:24am LPA observed (02) bathrooms to be clean and in proper operation. LPA observed appropriate grab bars in and around the toilet and shower in bathroom number one (01). The water temperature measured in range of 117.1 between 118.7 degrees Fahrenheit. Hand towels are not shared. Trash can contain lids. Extra linens and sheets were observed to be stored in a cupboard adjacent to the bathtub in bathroom number (01).