Facility Evaluation Report

Licensing Program Analyst (LPA), Natasha Persaud conducted an announced Pre-Licensing/Component III inspection. LPA identified herself and explained the purpose of the visit with Administrator, Philip Barlis and House Manager, Juna Barlis to ensure Title 22 compliance. An initial application was received by the Department on 09/15/2021. The Applicant/Licensee requested to be licensed for a capacity of four (4); Two (2) Ambulatory and Two (2) Non-Ambulatory Developmentally Disabled adults, ages 18-59.

Structure - The facility is a one story structure with 4 bedrooms, and 2 bathrooms. There is an outdoor covered area for client use. No bodies of water were observed. Per the Administrator, there are no firearms or weapons on the premises.

B edrooms Clients - Rooms #1, #2, will be used for Ambulatory clients only. Rooms #3, #4, will be used for Non-Ambulatory clients only.

Bedrooms Staff - There are no staff rooms.

Bathrooms - All bathrooms have a working toilet, sink, and non-skid rugs.

Linens & Hygiene Supplies - Adequate supply.

Emergency Phone Numbers, Exit Plan and Required Postings - Posted.

Smoke Detectors and Carbon Monoxide Detectors- Operational.

Appliances - Stove burners, oven, microwave, washer, and dryer working.

Water Temperature - Measured at 107 degrees F.

Medications- Centrally stored and locked in a closet.

First-Aid Kit - Stored in a locked cabinet.

Client & Staff Files - Located in a locked cabinet. cabinet.

Component III - Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance.