Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted a pre-licensing visit and met with Applicant. This facility is to serve 4 ambulatory individuals age 18 through 59 years old. Component III was also completed during this visit.

Carbon monoxide detector was tested and operable. It is located near hallway near the bedrooms.

Fire extinguisher located in the kitchen and garage. Service date: 03/13/21.

Cleaning solutions are locked inside a hallway closet and in the garage. Sharps are locked under the kitchen.

Building and grounds are free from hazards.

Mattresses and bedsprings are in good repair.

Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture.

Clients have the appropriate furniture (one chair, night stand, adequate lighting for each client adequate closet and drawer space).

There are enough bath towels, hand towels and wash cloths for all clients.

There are sufficient amount of linens available to permit weekly changing to ensure use of clean linens at all times by clients. There are extra supplies inside each bedroom.

Facility has a washer and dryer that are fully operational located inside the garage.

Pantry's cupboards, freezers, stoves, microwaves, refrigerator and counters are clean.

***Refer to LIC 809C for the continuation of this report***