Facility Evaluation Report

On 7/25/23, Licensing Program Analyst (LPA) Michelle Echeverria conducted an announced visit to the facility for the purpose of increasing the capacity. LPA was greeted and granted entrance by the Licensee, John A Cutshall.

Per the LIC200, John requested for the capacity increase from two (2) ambulatory to four (4) ambulatory on 05/03/2023. The fire clearance request was approved on 05/08/2023 for four (4) ambulatory clients.

There is a facility sketch on file with designation of capacity for each room. Per the facility sketch, bedroom #2 is for 1 client, bedroom #3 is for 2 clients and bedroom #4 is for 1 client. Licensee states that there has been a change to the facility sketch where bedroom # 3 is now for 1 client and a downstairs bedroom has been converted into a client's bedroom. LPA called and spoke to the fire inspection office where it was confirmed that the inspection was processed per the facility sketch included with the STD 850. LPA informed the Licensee that a new facility sketch and fire inspection would be required for a capacity change since there has been a change to the clients bedrooms. A subsequent visit will be conducted once the new facility sketch and fire inspection has been approved.

An exit interview was conducted where this report LIC809 was discussed and provided to the Licensee, John A Cutshall.