Facility Evaluation Report

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

This is a single story home with 4 bedrooms, 2 full-bathrooms and 1 half bathroom, living room, kitchen, dinning area, office and laundry room. The home has a detached garage.

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

Fire extinguisher located in the kitchen and laundry. Service date: 05/13/2021

Cleaning solutions are locked inside a cabinet located in the laundry room. 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.

Sufficient amount of personal hygiene supplies are available for clients.

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