Facility Evaluation Report

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. No Clients in care during time of visit. Facility is a single story residential home. LPA along with Administrators DJoana Agnes, Reb Agnes, and Marilyn Balmes toured facility.

Fire clearance approval was received on 02/03/21. Structure: Facility is a one story, 5 bedroom (4 Client rooms 1 staff room) 2 bathroom house with an attached garage with separate entrance through exterior. Home has a ivory 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 resident 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 provided and facility sketch posted. Food Service: Facility has 7 day non-perishables in the pantry. Facility has small supply of perishable foods. Perishables to be provided once facility receives clients. Emergency food and water supply on hand. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Fire extinguisher is mounted and charged. Facility has 1 extinguisher. Facility has audible alarms on all sliding windows and entrance/exit doors. Appliances: Stove and refrigerator are operational. Toxins : LPA observed toxins secured in locked location. Water Temperature: Tested and recorded between 107.7 to 111.9 degrees F. in facility bathrooms. Reading Material Games, and Equipment:

facility has Karaoke machine. 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 with a self latching gate on one side of facility as required. LPA observed shaded outdoor seating.