Facility Evaluation Report

Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct an annual inspection. LPA met with Tina Pham who granted LPA entry into the facility and assisted with a tour.

The facility is an Adult Residential Facility (ARF) with five (5) bedrooms, three (3) bathrooms in the home, LPA observed kitchen/dining area, living room and a family/dining area. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient furniture and lighting and is maintained at a comfortable temperature 73 degrees F.

LPA inspected the kitchen. Facility has sufficient nonperishable and perishable food for the number of clients in care. Facility has a variety of food available and menu is posted the food is stored in a safe and healthful manner. Sharps are stored and kept locked in a cabinet in the kitchen area inaccessible to clients in care.

LPA inspected client bedrooms. The bedrooms are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting.

LPA inspected the bathrooms. Bathrooms were operating in a safe and sanitary conditions. The hot water temperature measured at 107.5 degrees F.

LPA observed the facility is equipped with operating carbon monoxide/smoke detectors and fully charged fire extinguishers.

Posters such as personal rights and the disaster plan were posted in a common area.

LPA did observe cleaning supplies are kept in a locked cabinet in the kitchen inaccessible to clients in care.