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 for a change of ownership. LPA arrived at the facility and was greeted and granted entry by designated Administrator (AD) Deborah Seifert. An application to operate a Adult Residential Facility (ARF) for (6) capacity, (6) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 6/26/2023.

Structure: The facility is a one-story home with three resident bedrooms, two bathrooms, living room, kitchen, dining room, staff room, backyard and attached two car garage. There are two exit gates in the back yard. The backyard has a seating area.

Client Bedrooms: All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. Facility has extra chairs in the staff room.

Bathrooms: The bathrooms have working plumbing. Hot water measured at 110.2 degrees Fahrenheit in the common bathroom and 109.2 degrees Fahrenheit in the staff bathroom which residents use if necessary.

Linens: A supply of extra linen is stored in the hallway closet.

Emergency Phone Numbers, Exit Plan and Menu: Posted and available for review.

Activity Materials: The facility has a facility calendar with various outings for residents. Facility also has exercise equipment, dolls, electronics and more.

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