Facility Evaluation Report

Licensing Program Analyst (LPA) Rayshaun Nickolas made an announced visit to the facility to conduct a pre-licensing inspection for an initial application. LPA Nickolas identified herself to licensees Kenisha Polk and

DiJarnette Green advised them of the purpose of the visit.

The facility has been granted a fire clearance on 10/03/2022 by Apple Valley Fire Protection District for a total capacity of one (1) ambulatory resident and one (1) non-ambulatory resident.

The facility has a total of five (5) bedrooms, four (4) of which are residents', three (3) bathrooms, two (2) of which are residents', a kitchen and dining area, a living room, activity areas, and backyard. LPA and Licensees toured the interior and exterior of the facility. The facility has no bodies of water. There is a shaded seating area for residents outside. The facility had a working telephone for residents use. The facility has charged fire extinguishers, smoke alarms, and carbon monoxide detector. The facility had a complete first aid kit; however the facility needs to purchase a first aide manual. A locked centralized storage area for medications. The following were observed of the physical plant:

Client Bedrooms : LPA observed all bedrooms to have the required bedding and furniture, such as, clean mattresses/linen, sufficient storage space, chairs, and lighting.

Client Bathrooms: LPA observed bathroom appliances were operating in safe and sanitary conditions and contained appropriate hygiene items for clients.

Kitchen and Dining Area: LPA inspected the kitchen and found dishes, cups, and utensils were in good condition and stored in a safe manner.

Laundry Room: LPA observed cleaning supplies and sharps stored in the laundry room. LPA also observed cleaning supplies and sharps were kept in a safe and secured place. The cleaning supplies and sharps were stored in separate cabinets.