Facility Evaluation Report

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced Required 1 year inspection at the facility and met with Licensee/Administrator Maria Pliss and explained the purpose for todays visit. The facility is licensed to serve four (4) Developmentally Disabled Adults ages 18-59. Two (2) Non-Ambulatory.

The facility is a single story home consisting of four (4) bedrooms, one (1) staff room, (2) bathrooms, living room, dining room, kitchen, laundry area, a detached garage, and a front and backyard. There are no bodies of water at this location. Last Emergency Disaster Drill was on 08/24/25 and Administrator Maria Pliss

Administrator Certificate expires 12/17/26.

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.

· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen,and hallway to promote hand washing, cough/sneeze etiquette, and physical distancing.

· Four client rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Three (3) centrally stored client medication records were reviewed. ·

· Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

. Four (4) staff files were reviewed -criminal record clearance, current first aid, CPR and CPI. Staff files are maintained at the facility and kept in a secured location..

. Four (4) clients files were reviewed -Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.

The water temperature measured between 105F.-120F. Title 22 Regulations of between 105F.-120 F.