Facility Evaluation Report, 08/02/2022 — Positive Impact Home, Menifee CA

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility for the purpose of conducting a Pre-Licensing visit. Analyst met with Applicant Tiffany Dupree and toured the facility. Fire Clearance was granted for one (4) ambulatory residents on 6/9/22 by the City of Menifee Fire Department. The facility is going to apply to be vendorized through Inland Regional Center for developmentally disabled adults ages 18 - 59 once licensed. Home is set-up with living room, family room, kitchen, dining room, four (4) resident bedrooms, 2 restrooms, den, backyard, laundry room, and a garage.

LPA Colvin observed required accommodations in residents' bedroom and bathrooms including inspection of beds, mattresses, and closet space. Smoke detectors and carbon monoxide units are all operable, as observed by LPA Colvin when she tested them. Common areas such as dining and living rooms were observed to be clean and in good condition.

ADMINISTRATION/MEDICATION : Medication is to be stored in a locked cabinet in the kitchen and a file cabinet for record storage. Staff records include documentation on training for medication administration for all staff.

PHYSICAL PLANT : Outside premises were inspected for potential hazards. Cleaning solutions and other hazardous items are stored and locked in the cabinet under the kitchen sink. Outside gate was observed to be unlocked for clients' and staff's use in case of emergency as an exit. Exit route from backyard was observed to be free of obstruction. LPA Colvin tested the facility's hot water and observed it to be measuring at 92.4 degrees. LPA Colvin instructed applicant to raise the temperature of the hot water heater and measure again at a later date to ensure it does not exceed 120 degrees but is at least 105 degrees.

ACTIVITIES: Inside and outside, there are areas for residents to use for their leisure. Backyard is in good condition with outdoor furniture and a shaded area for the residents. Facility additionally has magazines, tv, books, and games for the residents to use.