Facility Evaluation Report

On 11/25/2024 at 8:57 AM, Licensing Program Analyst (LPA) Zina Brown made an unannounced visit to the above facility. The purpose of today's visit was to conduct an annual inspection of the facility. On today's visit LPA met with facility Shane Herbert, Executive Director. The facility profile shows that the facility is licensed for a capacity of six (6) ambulatory adults ages 18-59. The executive director stated that the facility has four (4) clients currently enrolled in the program: (4) ambulatory and (0) non-ambulatory. The executive director stated none of the clients have restricted health care conditions or utilize any protective devices. The last medical emergency was conducted 09/30/2024. The last fire drill was conducted on 09/20/2024. The facility provides transportation. The liability insurance is current and expires 06/21/2024 The facility current has a annual licensing fee at a balance of $0.

The facility is a one (1) story home located in a residential neighborhood, the property consists of the following: 4 client bedrooms, 2 bathrooms, a staff restroom, nurses office, staff office, living room, kitchen, dining room, attached garage which houses the washer and dryer and an backyard with outdoor shaded area and a therapy room.

LPA conducted a records review of (4) client records, (4) staff records, were reviewed the facility disaster plan. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) Client Medication Administrations Records and did not observed any discrepancies at the time of visit.