Facility Evaluation Report

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Direct Support Professional (DSP) Blount and was granted entry into the facility. House Manager (HM) Brenda Tafolla was contacted and arrived at the facility to assist LPA with the inspection. The facility is licensed to serve four (4) clients; of which 3 may be non-ambulatory. The facility is approved for delayed egress. During today's visit all three (3) clients were present.

An overall inspection of the facility began today however due to time constraints LPA was unable to complete the visit and will return at a later date to conduct the remaining portion of this inspection.

No deficiencies cited at today's visit. This report was discussed with House Manager Tafolla. A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report