Facility Evaluation Report

At approximately 9:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility announced, for the purpose of completing a pre-licensing evaluation. LPA met with Applicant Ross Evan Barlahan and toured the facility. The Facility is a 3-bedroom, 2-bathroom, single story home. Fire extinguishers were mounted and charged. Smoke detectors were tested and in working order. There was a carbon monoxide detector present. There was a locked area for medications and several for toxins and cleaning supplies. There is a secure area for resident records. Beds were made with appropriate linens. There were supplies of additional bedding stored for resident use. Resident rooms contained furniture as required in 3 of 3 rooms. Hot water temperature was tested and found to be within regulation between 105 degrees F and 120 degrees F at faucets accessible to residents. Facility has infection control posters located throughout the home. Hand sanitizer and/or hand washing locations are throughout the home.

A fire clearance for this facility has been granted for 4 Non-Ambulatory residents.

Component III orientation was conducted at facility. Applicant conveyed a good knowledge of Title 22 regulations.

The pre-licensing evaluation has been completed. LPA will submit the application packet for a final review and approval from the Licensing Program Manager.

This report was reviewed with applicant and a copy was provided.