Facility Evaluation Report

On 11/16/2022, Licensing Program Analysts (LPA) Wendy Gibbs conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation.

An application was submitted to Community Care Licensing Department (CCLD) on 04/20/2022 for an initial license for an Adult Residential Facility to Developmentally Disabled Adults for ages 18-59 years. The requested capacity is for (6) clients, four (4) non-ambulatory and two (2) bedridden.

Structure: The facility is a single-story house with four (4) bedrooms, three (3) full bathrooms, an office, living room, dining room, office space, kitchen, pantry and attached garage.

Physical Plant The front entrance has a ramp that leads to the front door. The front landscape is in good condition. The front is clean and clear of obstructions and debris. There is a ramp out the back door that leads to the back yard. Outside they have tables and chairs for clients to sit. The back landscape is in good condition. All walkways are free of obstructions and debris.

Bedrooms: All bedrooms have the required furniture: bed with proper linens, nightstand, lamp, dresser for individual residents, chairs for individual residents, and large closets in each room. Rooms 2 and 3/4 (same room, two entrances) are furnished for 2 residents.