Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman made an announced pre-licensing visit. LPA identified herself and discussed the purpose of the visit with Licensees Kevin Clark and Gerald Jones. An initial application to operate an Adult Residential Facility was received by CCL on 06/14/2021 for a capacity of 4 ambulatory residents. Administrator Gerald Jones has a current administrator certificate expiring on 06/23/2022. There are no clients in care during today's visit. Facility has covid signage in the facility and LPA observed the screening/ sanitation station in the entrance of the facility.

LPA Lyman along with Licensees Clark and Jones toured the facility at 9:19 AM and observed the following:

Structure: Facility is a two story, 4 bedroom, 3 bathroom house with an attached garage and a light tan exterior. The exit gate is closed and unlocked. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Clients: All bedrooms are single occupancy. All rooms are equipped with appropriate lighting, chair, night stand, ample closet space. Bathrooms: All client restrooms have a working toilet/ wash basin as well as paper towels in all restrooms. There are hand washing signs in all restrooms. Linens & Hygiene Supplies: Linen supply is in ample supply for clients in care. Emergency Phone Numbers and Exit Plan: Licensee to post in the entrance area of the facility. Food Service: Facility has ample 7 day non-perishables in the pantry. Facility to obtain perishable food upon acceptance of clients. LPA observed a sample menu. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguishers are fully charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins : Stored in a locked area in the garage. Water Temperature: Tested and recorded between 108.6 and 110.0 degrees F.in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. Licensee ordered a first aid manual during the visit. Medication to be stored and locked in a locked closet in the facility. Facility uses a medication administration record