Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Jason Taylor and explained the reason of the visit.

Facility is licensed to serve one (1) ambulatory and two (2) non-ambulatory clients between the ages of 18 - 59 years old. The home has a kitchen, a living room, a dining room, 3 bedrooms, 2 bathrooms, a back yard, front porch, and a detached garage.

LPA toured the home with Jason Taylor and observed the following:

The home is clean and in good repair outdoors, no large bodies of water in the facility. It is equipped with a sprinkler system and interlace smoke/carbon detector throughout the facility which were tested and working properly. Window in front door was broken cover with styrofoam, a work order is in place for repair. Each bedroom is equipped with sufficient lighting, furniture, and bedding supplies. LPA did not observed bedroom #2 as client did not allow us entry. Bathrooms (2) were observed in working condition and water temperature was tested between 109.9 - 114.7 degrees F., which is within the required 105-120 degrees F. Kitchen was observed clean, in working condition. Cleaning supplies were stored/locked under the sink and on a cabinet on top of the washer. Food was observed sufficient for at least 2 days of perishables and 7 days of non-perishables. Fire extinguisher was observed in the kitchen.

LPA review files for 3 clients and 5 staff. Client #1(C1) does not have a physician's report/TB clearance on file. Staff #3 - #5(S3-S5) do not have a health screening/TB clearance on file, and Staff #2(S2), S3,S5 do not have a CPR/First Aid training.

Emergency disaster plan was review and last fire drill was provided on 9/15/23.

Deficiencies are noted on LIC 809D per Title 22 Regulations.

Exit interview was conducted with Luther Waters administrator and a copy of this report, LIC 809D, and appeal rights were provided.