Facility Evaluation Report

Licensing Program Analyst (LPA) Jennifer Semin conducted an announced visit to complete a pre-licensing inspection and component III. LPA met with House Manager, Helga Barrow and spoke with Licensee Sharon Davidson via telephone.. The application is for a Adult Residential Facility for six (6) ambulatory only clients.

A tour of the pending facility was conducted inside and out. Overall, the pending facility is clean and of newer construction. There no pools, bodies of water, firearms or ammunition. LPA observed all bedrooms to be appropriately furnished with adequate lighting. Bathroom toilets, showers and tubs have non-skid mats. The hot water temperature was measured in the clients bathroom at 105 degrees Fahrenheit. LPA observed food storage and preparation areas to be clean and sanitary. Refrigerator and freezer temperatures are maintained at appropriate temperatures. All appliances are clean and operating properly. There is a sufficient supply of linens, towels, and personal hygiene items. The first aid kit was reviewed; all items are present including a First Aid Manuel. LPA observed a minimal supply of recreation and leisure items and activities. The backyard is completely enclosed with functioning gate to exit to front yard. Outdoor space is suitable for client use that includes a table and chairs with shade. LPA observed the fire extinguishers to be recently serviced and completely charged. Smoke alarms and carbon monoxide detectors are present and functional. Medications are centrally stored and secured in a locked cabinet. All hazardous materials such as, cleaning and disinfecting supplies, knives and other sharps are locked and inaccessible to clients. All required forms are posted in a common area.

Pre-Licensing is complete and has no deficiencies.

An exit interview was conducted where this report was discussed and provided to Ms. Barrow.