Facility Evaluation Report

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 10:00 AM, LPA met with Licensee/Administrator Andy Adams. An initial application for Adult Residential Facilities (ARF) was submitted to the Central Applications Bureau (CAB) on 10/28/2021 for a total capacity of five (5) non-ambulatory residents. Fire clearance was granted on 12/10/2021. LPA Delgado observed the following:

Facility was a one-story house with five (5) resident bedrooms, two (2) resident bathrooms, half (1/2) bathroom, living room with dining area and kitchen. There was an attached two car garage in the front of the house.

Central heating and air conditioning system installed with a central panel located in the hallway to control entire house.

Each resident bedroom #1, #2, #3, #4 and #5 will accommodate any non-ambulatory resident. 5 resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. #5 needs a chair

The (2) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. At 10:44 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 106.6 degrees Fahrenheit.

An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a tool box located in the hallway closet #1. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition.