Facility Evaluation Report

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility at 1:20 pm and was greeted and granted entry by designated Administrator (AD) Naresh Sharma. An application to operate an Adult Residential Facility (ARF) for (4) capacity, (4) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 7/3/2023.

Structure: The facility is a one-story home with four resident bedrooms, two bathrooms, living room, kitchen, dining room, backyard and detached two car garage. There is one exit gate in the back yard. Based on review of facility sketch, LPA noted that there are no arrows pointing to the backyard exit gate. Administrator stated they will update the facility sketch to show the exit path in the backyard and email the updated sketch to LPA and CAB Analyst. The facility has patio chairs but no table. LPA also observed the following items in the backyard: a pile of cardboard boxes next to one of the bushes, a doghouse with chipped paint and warped wood, a crate of unused bathroom tiles, a rusted paint can, unused trash cans and bags of fertilizer that have been ripped open. AD stated the facility has no immediate plans to get a dog.

Client Bedrooms: All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened.

Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored and in the garage.

Medications, First-Aid Kit & Files: Medication will be stored in a locked cabinet in the hallway. First Aid Kits will be stored with medication and in the kitchen. Records will be kept in a cabinet beneath the medication.

Fire Extinguisher: LPA observed fire extinguisher to be fully charged