Facility Evaluation Report

Licensing Program Analyst (LPA) Jesse Gardner conducted an announced pre-licensing inspection to the facility to complete the pre-licensing inspection and Comp III. Upon arrival, LPA met with Administrator Shiloh Cloyd. Administrator Cloyd accompanied LPA on a tour of the inside and outside of the facility.

Currently there are no residents in care. The facility is a 4 bedroom, 2 bathroom home with a living room and kitchen. Per the approved fire clearance, the licensee is approved for 4 ambulatory residents. All bedrooms are furnished with bed, night stand, dressers and have adequate lighting for residents use.

The facility currently has paper towels in the restrooms, linens, towels and a sufficient amount of hygiene products for residents. The water temperature was tested and measured between 118.0-119.8 degrees Fahrenheit. The smoke alarms and carbon monoxide alarm were tested and are in operating order. LPA observed a fully charged fire extinguisher which was present in the kitchen/living room area. The kitchen was observed to have dishes, silverware and pots and pans. The medications, will be stored with the knives in a locked cabinet in the kitchen. The chemicals will be stored in a locked cabinet in the hallway.

The backyard was observed to be fully fenced with an unlocked gate and shade will be provided by an umbrella and table combination.

LPA found all facility features to be in compliance and in line with Title 22 Regulations.

An exit interview was conducted and a copy of this report was reviewed with and provided to Administrator Shiloh Cloyd.