Facility Evaluation Report

Licensing Program Analyst (LPA) Kruz Long conducted an announced visit to the facility for the purpose of a pre-licensing evaluation. Upon arrival, LPA met with Herbert Amanya who assisted with the visit.

An application was received on 05/19/21 for Initial License #198603491 Adult Resident Facility to serve age range 18 to 59. The requested capacity is for 4 ambulatory only.

The facility is a single story house located in a residential area which consist of a living room, 3 Client bedrooms, kitchen, dining area, 1 1/2 bathroom, shower room, laundry, attached garage/office. There is a large, covered patio area. The client bedrooms are spacious and will easily accommodate the client's furnishings. Passageways, walkways, driveway, step and patios are free of obstructions. Front, back and side areas are free of hazards, such as ladders, gardening tools, motorized equipment. Client bedroom have beds, chairs, night stands, lamps in addition to overhead lighting. There are dressers with drawers, which comply with the requirement of 8 cubic feet of space. No bedroom designated for awake-staff. Bathroom have a working toilet, wash basin and stand up showers. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Emergency Phone Numbers, Exit Plan & Menu are posted & readily available for review next to the main entrance. Fire Extinguisher located in the dining area mounted to the wall. Telephone system is a land line located in the kitchen. Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer next to the sink. Food supply adequately stored in kitchen cabinets and refrigerator. Smoke Detectors and Carbon monoxide detector are operational. Stove burners, oven, microwave, washer, and dryer working. There is one refrigerator in the kitchen. Toxins are l ocked and stored under the kitchen sink cabinet. Hot water temperature tested at 112.7 degrees F in the bathroom. A first aid kit has been inspected and consist the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the hallway closet available for staff use but inaccessible to clients. Continue to LIC809C.....