Facility Evaluation Report

Licensing Program Analysts (LPA's) Jenifer Tirre and Michael Tea made an announced pre-licensing visit. LPA's identified themselves and discussed the purpose of the visit with Licensee/Administrators Djhoana Agnes, Reb Agnes, and Marilyn Balmes. An initial application to operate a Adult Residential Facility was submitted to CCL on 9/18/2023. There are 0 clients in care during today's visit.

LPA's Tirre and Tea along with Licensee Agnes and Administrators Agnes & Balmes toured the facility at 9:26 AM and observed the following:

Structure: Facility is a one story, 5 bedroom (4 clients bedrooms and 1 live in staff bedroom) 3 bathroom house with attached garage and a blue exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All clients bedrooms meet Licensing requirements. Bathrooms: All client bathrooms have a working toilet, wash basin, and bathtub/shower as well as non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as adequate emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Facility has one Fire extinguisher that is mounted and charged. Facility has audible alarms on all sliding/exit doors. Appliances: Gas Stove, microwave, refrigerator, washer and dryer are operational. Toxins : LPA's observed toxins secured in laundry storage area.. Water Temperature: Tested and recorded between 108.8 to 124.1 degrees F. in facility bathrooms. Reading Material Games, and Equipment:

facility has puzzles, games, and sporting equipment. Facility has I-Pad device with access to internet for clients use Medications, First-Aid Kit & Book: Facility has first aid kit & First aid handbook present at the facility.