Facility Evaluation Report

On 6//08/26, 9 :50 am, Licensing Program Analyst (LPA) Raymond Comer conducted an unannounced annual visit to this facility. LPA was greeted by the facility House Manager who then contacted the Assistant Administrator and informed them that LPA Comer was in the facility; LPA spoke directly with the Assistant Administrator and reason for the visit was discussed. Per the Assistant Administrator, she was unable to meet LPA. However, the House Manager assisted LPA during this annual inspection visit.

Facility is licensed as a single-story residence; fire clearance is licensed for six (6) total ambulatory clients (Severe developmentally disabled) Ages: 18 to 59 years of age. Facility has a total of three (3) bedrooms, and two (2) bathrooms for clients’ use. At 10:25 am, LPA conducted a tour of the physical plant with the House Manager and observed the following:

Physical plant: was inspected for cleanliness and condition . Facility’s main door is the primary entry/exit access. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 73.0°F. within the required range. Required postings are prominently displayed and observed to be current. Passageways and entrance were clear of obstruction. Most recent fire drill and earthquake drill conducted on 06/07/26.

Medications: Are centrally stored and locked in a medication cart. Each centrally stored prescription and PRN medication has been logged in the medication administration record (MAR) with proper documentation. LPA observed a fully stocked First-aid kit above the medication cart.