Facility Evaluation Report

Licensing Program Analyst (LPA) Paola Guerrero conducted an announced pre-licensing visit to facility. LPA met with Administrator Vicki Estelle. The pending application is for an Adult Residential Facility (ARF). Currently there are 0 residents present. Administrator Vicki accompanied LPA on a tour of the inside and outside of the facility. The home is a five (5) bedroom, three (3) bathroom home with a living room, dining room, and kitchen. The physical plant, in general, was in good repair. Buildings and grounds are free from hazards. Indoor and outdoor passageways are free of obstruction. There are no pools, bodies of water, firearms, or ammunition. All bedrooms are furnished with a bed, night stand, dresser, and chair. All bedrooms have adequate lighting for resident use. Bathroom's toilet, shower and tubs are in good repair and have non-skid mats. LPA measured and observed the water temperatures in the bathrooms to be at 117.5 degrees F. LPA observed food storage and preparation areas to be clean and sanitary. Refrigerator and freezer are maintained at appropriate temperatures. All appliances are clean and operating properly. Dishes, glasses, and utensils were in good condition. There is a sufficient supply of linens, towels, and personal hygiene items. The first aid kit was reviewed; all items are present. The backyard is completely enclosed with functioning gate to exit to front yard. Outdoor space is suitable for client use. LPA observed fully charged fire extinguisher present in the facility. Smoke alarms and carbon monoxide are present and functional. The facility had a designated area for staff and client records. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There is adequate seating in the common areas. Facility had a supply of activities for the clients.

Pre-licensing inspection is complete, and no corrections are needed to be made.

An exit interview was conducted, and a copy of this report was provided to Administrator Vicki Estelle.