Facility Evaluation Report

Licensing Program Analysts (LPA) Sanjay Vaid made an announced visit and met with Administrator Cameron Clayton to conduct an announced Pre-Licensing evaluation.

An application was submitted to Community Care Licensing Department (CCLD) on for an initial application of a Adult Residential Facility (ARF) to serve adults between the ages of 18 - 59. The requested capacity is for six (6) ambulatory only clients. Structure : Facility is a single-story home located in a residential area consisting of five (5) client bedrooms private bedrooms, one bedroom is shared by two clients the other four are single occupancy, two (2) bathrooms, kitchen/dining room, living room, laundry area is located in the garage area of the facility and is inaccessible to clients. Backyard has a covered shaded area. Front yard is fenced and landscaped with grass and back yard is landscaped with cement and gravel. Bedroom Clients: Each four (4) private and one (1) shared client bedrooms. Bedrooms are equipped with one bed, nightstand, lamp, and overhead lighting, chairs for each of the clients. Bathrooms: Two (2) full bathrooms equipped with working toilets, wash basins, bathtub/ walk-in shower. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in hallway closets.

Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. Two (2) fully charged fire extinguishers were observed. Facility has a land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible in the locked staff room. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Emergency water supply was observed. Smoke Detectors: There are electrical smoke detectors located in all bedrooms, common areas, and hallways, and are interconnected.