Facility Evaluation Report

Licensing Program Analyst(s)(LPA) Mary Flores conducted an announced pre-licensing visit at the facility. LPA met with Bernadette Stephenson - Applicant.

Fire Inspection Clearance was conducted on 8/29/22 and facility is cleared to serve 4 ambulatory clients between the ages of 18 - 59 years old. The physical plant consist of; A single family home located in a residential neighborhood with a living room, dining room, kitchen, (3) client bedrooms, (1) bathroom, a front porch, a deck in the back, a back yard. Detached garage, storage shed, and an office in the back which will be inaccessible to clients.

LPA Flores conducted a tour with Bernadette Stephenson applicant and observed the following:

Sofa cushion has design seams which is rip about 1/2 an inch in two areas. Carpet has debris and paint stains.

Provides a sitting area with a large dining table, dining room floors have smear stains around the dining table.

Bedroom #1(BR1) will be a shared bedroom, one night stand was observed, carpet has paint stains smear the size of 3 ft by 2 ft. Bedroom #2(BR2) will a single room and has the required furniture. Bedroom #3(BR3) will be a single room and has all required furniture, a antenna cord was observed sticking out of a hole the size of a quarter. Each bed is missing either a flat sheet,and/ or blanket.

Bathroom's water temperature was tested at 119.2 degrees F., which is within the required water temperature of 105-120 degrees F. No paper towels were observed. Toilet, and shower are in working condition. During temperature test water was stopped on sink and did not properly drained.