Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra and Associate Governmental Program Analyst (AGPA) Michael Monriel II conducted a pre-licensing visit.. LPA met with Shauna Williams (Applicant). The facility is to serve 6 ambulatory individuals over the age of 60. This is a 2 story home which consist of (3) bedrooms, (2) baths, living room, kitchen, dining area, office (upstairs) and an attached garage with the laundry unit. Component III was also completed during this visit.

Carbon monoxide detector was tested and operable. Located near the garage door. No carbon monoxide in the upstairs section of the home.

Fire extinguisher is located in the kitchen.

Cleaning solutions and sharps are locked in the kitchen under the sink.

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.

Residents have the appropriate furniture (one chair, night stand, adequate lighting for each client adequate closet and drawer space). Note: This home was set up for 4 residents and not 6 as noted on the application. Applicant to set home up for 6 Residents.

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

Sufficient amount of personal hygiene supplies available for Residents.

There are sufficient amount of linens available to permit weekly changing to ensure use of clean linens at all times by Residents. ***Refer to LIC 809C for the continuation of this report***