Facility Evaluation Report

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Lori Cook was notified via telephone but could not arrive to assist with today's inspection. LPA observed that Lori Cook has a valid Administrator certificate which expires on November 20, 2025.

The facility is an Adult Residential Facility (ARF) licensed for six ambulatory clients. The facility is a single story home with three private client bedrooms, two shared client bathrooms, a living room, a dining room, a kitchen, two staff bedrooms, and an attached two car garage. LPA, accompanied by a caregiver, conducted a tour of the interior portions of the facility. On today's visit, LPA observed two clients in care and one care giving staff present. LPA observed clients returning from their respective day programs. LPA inspected the three private client bedrooms and they were observed to be free of hazards. LPA observed client bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed client beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared client bathrooms and observed them to be clean. Faucets and toilets were operational. Hot water temperature measured between 119.2 degrees Fahrenheit. LPA observed the two staff bedrooms to be kept locked and inaccessible to clients in care.

LPA observed the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet under the sink. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet. CONTINUED ON 809-C