Facility Evaluation Report

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced site visit for the Annual/Required inspection. Upon arriving at the facility, LPA met with Staff / Quiana Robinson and was later joined by the Assistant Administrator / Nancy Parker who assisted with the visit. The facility is licensed to serve six (6) Developmentally Disabled Clients ages 18 - 59 years of age. The facility is approved for six (6) Ambulatory Clients only. Currently, there are five (5) clients in placement. During today's visit, LPA used the infection control domain to complete the Required - 1 Year inspection. Also, the physical plant was toured, medication and food supplies reviewed.

The facility is located in a residential area. A tour of the single-story facility includes: Three (3) client bedrooms, two (2) bathrooms, living room, kitchen, dining area, laundry area and indoor/outdoor activity areas. All medications for residents who need assistance are kept locked and inaccessible to other clients. Knives, disinfectants and cleaning solutions are kept locked and inaccessible to clients. The bathrooms are clean and operational. Client bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The hot water temperature was tested throughout the facility. The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. LPA reviewed client medications.

Smoke detectors and carbon monoxide detectors are operable and in compliance. LPA observed a pull-switch fire alarm behind the entrance door. The fire extinguishers (2) were fully charged and in compliance. There is a functioning telephone on the premises. The facility has central heating accommodations. The washer and dryer are located in the laundry area (near the kitchen). The first-aid kit is fully stocked w/First-aid Manual. The front yard is well landscaped with steps and/or a ramp that leads to the entry. A shaded area with chairs is provided in the back yard. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. The trash cans have covered lids. There is no evidence of bodies of water (pool) or

(please see LIC 809C for additional information)