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. LPA arrived and was greeted and granted entry by designated Administrator (AD) Joesph Nassif. An application to operate an Adult Residential Facility (ARF) for (6) capacity, (5) ambulatory, (1) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 8/14/2023.

Structure: The facility is a one-story home with six client bedrooms, three bathrooms, staff bedroom, living room, TV room, kitchen, dining room, an attached two car garage, shaded patio and backyard. The garage is utilized as both storage and an office space for staff. LPA observed a lock on the garage door to prevent client access. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entryway. There is a back yard with one exit gate. There is one shaded seating area in the backyard. LPA did not observe any obstacles or hazards in the backyard.

Client Bedrooms: All client bedrooms have the required furnishings. LPA observed all resident beds have linens and blankets. LPA observed all windows were screened.

Toxins: LPA observed cleaning chemicals to be stored and locked in cabinets in the garage.

Medications, First-Aid Kit: Medication/first aid kit are stored in a locked cabinet in hallway near the TV room.

Resident & Staff Files: Records will be locked in the garage.

Fire Extinguisher: LPA observed the fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. LPA observed a service tag for the fire extinguisher which indicates the fire extinguisher was last serviced on 5/11/2023.