Facility Evaluation Report

***Due to technical difficulties, the Type of Visit could not be indicated as a Pre-licensing visit on the original report issued. This is an exact copy:

Licensing Program Analyst (LPA), Stephanie Torres, conducted an announced pre-licensing inspection at the facility. The LPA met with Licensees, Wilton Miles and Don Jobe. There are currently no clients in care.

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

Buildings and Grounds: The home is composed of four (4) client bedrooms, one (1) staff room/office, two (2) sitting rooms, three and a half (3 1/2) bathrooms, a laundry area, kitchen and dining areas (2), garage, and front/back yard areas. The interior/exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable. There are no pools or other bodies of water located at the home. According to Miles, there are no weapons stored in the home. Rooms, furniture, beds, mattresses appeared to be in good repair. The bedrooms are fully furnished, and privacy is available. The dining and living room areas are clutter free and in good condition. Outdoor areas had sufficient room for activities and leisure. A washing machine and dryer are available and in working order.

Storage and Supplies: Medications will be stored in a locked hall closet, inaccessible to any unauthorized individuals. Secured areas are available for facility files and client files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away in a secured kitchen cabinet. 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 stove are