Facility Evaluation Report

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a two story residential home. LPA along with Compliance Manager Laura Hagan toured facility at 7:49 AM and observed the following:

Fire clearance approval was received on 07/10/24. Structure: Facility is a two story, five bedroom (three shared Client bedrooms and two staff offices) 3 bathroom house with attached garage. 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 bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and 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. 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 are centrally wired and were tested operational. Facility has three Fire extinguishers which are mounted and charged. Appliances: Gas Stove and refrigerator are operational. Toxins : LPA observed toxins secured in laundry storage area inside garage. Water Temperature: Tested and recorded between 107.6 to 116.0 degrees F. in facility bathrooms. Reading Material Games, and Equipment:

facility has games available. Medications, First-Aid Kit & Book: Facility has three first aid kits 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 both sides of facility as required. LPA observed shaded outdoor seating. Facility has a Inaccessible pool with a secured fence and pool cover.