Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted an announced Prelicensing and Component III visit using the complete CARE Inspection Tool. LPA Yee met with Thomas McNulty, Applicant. Also participating in today's visit were Maria Dahlmann, Designated Administrator, Barbara Kimberling, Regional Program Director, Matthew Longoria, Compliance, Darren Longnecker, IT, and Shawn Mokricky, Maintenance.

The facility is a single storey family home consisting of a dining room, front room, a kitchen, a living room, four bedrooms of which one is designated as an office, a common bathroom and a private bathroom located in the bedroom identified as room #4. Located in the back is a separate building with a separate address of 12207 Kittridge Street. No bodies of water observed on the property. The facility is fire cleared for 6 AMBULATORY clients.

The following were observed on today's visit:

the front room is furnished with a chair, shelf, a desk and 2 chairs. Located in the front room is also a wood burning fireplace that will be closed off with plexiglass. A fire extinguisher that was last serviced on 3/13/24 was also observed

the dining room is furnished with a long table and 8 chairs

the kitchen is equipped with a refrigerator, stove, dishwasher, microwave, coffee maker. Sufficient dinner plates, cups, utensils and pots and pans were observed. There were no perishables purchased and insufficient non-perishable foods for a minimum of 7 days were observed

the living room is furnished with a L-section sofa, armchair and a wall mounted television. Located in the living room is a second fire extinguisher also serviced on 3/13/24.