Facility Evaluation Report

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an announced pre-licensing inspection at the home and met with Applicant, Etta Simpson.

Application : The inspection is for an initial Adult Residential Facility (ARF) application. The fire clearance has been granted for four (4) ambulatory clients.

Buildings and Grounds: The home is composed of four (3) client bedrooms, one (1) staff bedroom/office, two (2) living room areas, three (3) bathrooms, a laundry room, kitchen, one (1) dining area, a garage, and front and back yard areas. The interior and exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors are in working order. There are no pools or other bodies of water located at the home. There are no weapons stored in the home. Client bedrooms are fully furnished, and privacy is available. Outdoor areas had sufficient room for activities and leisure. A washing machine and dryer were available and in working order.

Storage and Supplies: Medications will be stored in a locked cabinet, inaccessible to any unauthorized individuals. Secured areas are available for facility files, staff files and client files. A complete first aid kit was observed to be available. Cleaning supplies will be stored away in a secured location. Linens, and equipment appeared to be in good repair and sufficient for the approved census. Fire extinguishers were available and fully charged.

Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and freezer are in working order. Sharps will be stored in a locked area, available only to authorized individuals.

Forms: The following signs were observed to be posted at the home: Personal Rights, Complaint information