Facility Evaluation Report

Licensing Program Analyst (LPA), Debbie Correia, conducted an announced Pre-licensing Inspection. LPA met with Applicant Tu, LPA identified herself, was granted entry into the facility and stated the purpose of the inspection. Facility’s Fire Clearance was granted on September 09, 2024, for six (6) developmentally disabled clients, ages 18-59, four (4) of whom may be non-ambulatory.

LPA was accompanied by Applicant Tu conduced a facility tour, inside and out of the facility grounds. Facility has one or more operating smoke alarms and carbon monoxide detectors that meet statutory standards. Facility had no bodies of water on the property. Per the Applicant there will be no firearms or ammunition kept on the facility grounds. LPA observed a seven day supply of non-perishable food items. There are two bathrooms, both bathrooms were in good repair and equipped with required grab bars and non-skid floor mats. Facility fixtures and appliances were all operable, sanitary, and in good repair. The facility water measured at 113 degrees Fahrenheit and the facility ambient temperature was 74 degrees. The facility is equipped with locked storage areas for medication, sharp objects, and toxins, as well as locked cabinetry for facility staff and client records. Facility has activities available for clients, a common area, and outdoor area including a shaded area for client activities.

In accordance with the Department’s Infection Control, LPA evaluated, and observed the facility's plan for implementation of the infection control testing surveillance, and screening protocols for universal entrance, as well as the use of personal protective equipment (PPE).

Based on today’s inspection, facility is recommended for Licensure. An exit interview was conducted and a copy of this report and Licensee/Appeals Rights (9058 01/16) were be provided to Applicant Tu whose signature on this form confirms receipt of these documents.