Facility Evaluation Report

Licensing Program Analyst (LPA) Kennedy conducted a Prelicensing/Component III Visit to observe the physical plant for compliance. The LPA was met and granted entry into the facility by Christina and Ward Crocker, applicants. The LPA and the applicants toured the physical plant and observed by the LPA were resident accommodations including furnishings, linens and personal hygiene items; resident bathroom is equipped with non-skid flooring and water temperature read 112 F; resident, staff, and facility records are located in a locked file cabinet in the office area of the house; food service including dishes, utensils, food storage and a seven day supply of nonperishables and a two day supply of fresh perishables are present; toxic substances are stored locked in the laundry room and in a locked cabinet in the kitchen; medication storage and administration logs are located in locked closet; first aid kit and first aid manual are located in the medication closet; activities, supplies and sufficient space to conduct are present; smoke and carbon monoxide detectors are present and operable; facility posting requirements are present in a common area and the facility administrator's certification is current; a pool is is present at the facility and a fence surrounding the pool is present that meets the required regulations; there are guns and ammunition located on the property. The guns are locked in a gun safe and the ammunition is stored in a locked box separate from the guns. Discussed with the applicants were continuing operation requirements, record keeping and physical plant compliance. The applicant shall contact the Centralized Application Unit (CAU) for completion of this pending facility application.

An exit interview was conducted with Christina and Ward Crocker, applicants. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Ms. Crocker via email. An electronic response confirms the documents were received.