Facility Evaluation Report

At approximately 10:20am, Licensing Program Analysts (LPAs) Angela Panushkina and Perchui Milena Khurshudyan conducted an unannounced annual visit. LPAs met with the House Manager, who granted access to the facility. Administrator arrived shortly after and LPAs explained the reason for the visit.

Physical tour was conducted with the Administrator and LPAs observed the following:

Kitchen: At approximately, 10:30am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet. Bedrooms: Facility has five (5) bedrooms designated for clients use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has awake staff.

Bathrooms: LPAs observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. Hot water temperature measured at 118.4°F. Medications: At approximately, 10:40am LPAs observed medications are centrally stored and locked in the office cabinet. Common Areas : The facility maintains a comfortable temperature at 72°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Laundry is located by the bedroom #5. LPAs observed all detergents locked in a cabinet and inaccessible to clients in care. Garage: Facility has an attached garage and is currently converted into a GYM. Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility, and at 10:55am they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational. Outside areas: At approximately, 11:00am LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients. Lawn is properly maintained. There is a swimming pool, which has a five-foot fence around its parameters to prevent clients from entry unsupervised. In order to gain access, the fence has a gate which will be locked at all times. Continue on LIC809-C