Facility Evaluation Report

Licensing Program Analyst (LPA) Bernadette Allen and Amy Goldenberg conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. This visit was conducted via facetime due to COVID-19 as a precautionary measure. An initial application to operate a Adult Residential Facility was submitted to the Central Applications Unit (CAU) on 8/4/2021 for a total capacity of 4 ambulatory residents. Fire Clearance was granted 11/05/2021 LPA's Bernadette Allen and Amy Goldenberg observed the following:

Structure: Facility was a single story house with four (4) resident bedrooms, two bathrooms, living room, dining area, and kitchen area.

Heating/Cooling System: Central heating and air conditioning systems.

Bedrooms: Each resident bedroom will accommodate ambulatory only clients. All bedrooms were adequately furnished with bed, chair, large closets, appropriate linens, adequate lighting, and an operational smoke alarm.

Bathrooms: Bathrooms have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Water temperature measured by applicant and thermometer read by LPA at 105.6 F.

Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet and drawer.