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 Daniel Datcu toured facility at 9:54AM and observed the following:

Fire clearance approval was received on 02/03/22. Structure: Facility is a one story, 7 bedroom (6 Residents bedrooms and 1 live in staff bedroom) 4 bathroom house with separate garage and a beige exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: All resident 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 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 detector are centrally wired and were tested operational. Fire extinguisher is mounted and charged. Facility has 2 extinguishers. Facility has audible alarms on all entrance sliding/exit doors. Appliances: Electric Stove and refrigerator are operational. Toxins : LPA observed toxins secured in laundry storage area.. Water Temperature: Tested and recorded between 123.4 to 125.0 degrees F. in facility bathrooms. Reading Material Games, and Equipment:

facility does exercises, board games, magazines and newspapers. 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 both sides of facility as required. LPA observed shaded outdoor seating.

Administrator's Certificate observed on wall expiring March 12, 2024