Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted an announced Pre-Licensing visit. LPA met with Licensee Anthony Johnson and explained the reason for the visit. An application was submitted to Community Care Licensing Department (CCLD) for a change in ownership of an Adult Residential Facility to serve 4 ambulatory clients in the age range of 18 through 59. The fire clearance has been approved for 4 ambulatory clients. At the time of visit all 4 clients were in the Day Program.

LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards.

The single-story facility included: living room, kitchen, dining area, office/staff room, 3 client bedrooms

(2 private, 1 share), laundry area in the hallway, front yard and back yard. Backyard has a shaded seating area for clients use. There is a detached garage in the backyard and inaccessible to clients. The home doesn't have any pools. Windows and window screens are in good repair. There are 2 fireplaces located in the living room and in the office area which are covered by a screen. Passageways, walkways, driveway are free of obstructions. Front, back and side areas are free of hazards.

Bedrooms were observed to have the required furniture such as bed frames, dressers, chairs and sufficient closet space. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket. Extra linens, blankets, towels, and personal hygiene supplies were observed. Bathrooms are clean and have a working toilet, wash basin, bath tub/shower. LPA tested the hot water temperature and was 110.3 degrees F*, which is within the required 105 - 120 degrees. All appliances in the kitchen were observed to be clean and operational. LPA observed at least 2 days of perishable and a minimum of 7 days of nonperishable food. Knives, cutlery and the sharp kitchen utensils are stored in a locked cabinet in the laundry area. All chemicals are locked in the garage and inaccessible to clients. The home has all the required posters posted. Continue 809C