Facility Evaluation Report

On 08/25/2024 at 1:00 pm, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Stephanie Smith and the purpose of today’s visit was explained. The facility is licensed to operate for (3) ambulatory, (0) non-ambulatory, (0) bedridden for adults ages 18 through 59 (developmentally disabled. Currently, the home has (3) clients. The clients are (Harbor Regional Center) clients. None the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices.

The facility has a current administrator certificate (#7016544735) for Stephanie Smith valid from 05/12/2024- 05/11/2026. The facility fees are current. The facility has liability insurance with Berkshire Hathaway Homestate Insurance Company (NAIC#20044) with each occurrence at $1,000,000 and general aggregate at $3,000,000 (policy #AMWC661086) effective date 08/04/2025 - 08/04/2026

The facility is a one (1) story home located in a residential neighborhood. The property consists of the following: three (3) client bedrooms, two (2) common bathrooms (with one (1) of the bathroom having a washer and dryer attached), staff office, living room, kitchen (water temperature tested at 106.3 °F ), dining room, a garage (with a fridge for overflow of groceries), and an outdoor shaded area (with a table and chairs).

Between the hours of 1:51pm - 2:30pm, LPA conducted a records review of (3) client records, (4) staff records, (3) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. Between the hours of 1:09pm - 1:21pm, LPA reviewed (3) Client Medication Administrations Records and did not observed any discrepancies at the time of visit.