Facility Evaluation Report

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year visit and met with Staff Member, William Gavgavian and Administrator, John Coleman. Facility is an Adult Residential Home that provides care and assistance for Adults with Mental Health Diagnoses. Upon arrival, LPA were informed there were currently 8 clients in care and 2 staff members on site.

At approximately 9:20AM, LPA reviewed the Facility's Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation. LPA reviewed staff files and medication. Staff files were all found to be well organized, thorough and contained the required documentation. Staff have current first aid/CPR certification. Medication was observed to be centrally stored and secure.

Facility's last emergency/disaster drill was February 2024. Facility's fire system was last inspected January 2024.

LPA requested the following documents to update facility file:

Designation of Facility Responsibility (LIC 308)

Active and Current Administrator Certificate

Documents to be submitted to Community Care Licensing (CCL) by due date of 06/16/2024.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.