Facility Evaluation Report

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Administrator/ Licensee Leland Wilson toured facility at 7:30AM and observed the following:

Fire clearance approval was received on 05/09/24. Structure: Facility is a one story, 3 bedroom (2 Clients bedrooms and 1 live in staff bedroom) 2 bathroom house with work room unit for activities located behind house. Facility has no garage and a gray exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All Client bedrooms meet Licensing requirements. Bathrooms: All Client bathrooms have a working toilet, wash basin, and bathtub/shower. Restroom has non-skid surface mats 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 emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested operational. Fire extinguishers are mounted and charged. Facility has 2 exting uishers. Facility has sharps and toxins secured in storage area.. Water Temperature: Tested and recorded at 112.6 degrees F. in facility bathrooms. Reading Material Games, and Equipment:

facility has games, books and pet therapy Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall on one side and Gate with lock on other side of facility. LPA observed shaded outdoor seating.

Administrator's Certificate observed on wall expiring 11/3/2026