Facility Evaluation Report

Licensing Program Analyst (LPA), Tiffany Holmes conducted an announced Pre-licensing inspection. An initial application to operate an Adult Residential Facility was received on 08/05/2024. The facility was approved to care for four (4) adult Residents; all ambulatory. LPA was greeted and allowed entry into the facility by and met with Applicant, Garrick Charlton .

Structure - The facility is a double story structure with 4 bedrooms and 3 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed.

Bedrooms Residents - Rooms #1, #2, #3, & #4, for ambulatory use only.

Bathrooms - All bathrooms have a working toilet, sink, tub/showers with non-skid mats.

Linens & Hygiene Supplies - Adequate supply.

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

Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired.

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

Water Temperature - Measured at 103.8, 107.6, and 108.1 degrees F.

Medications- Centrally stored and locked in a cabinet.

First-Aid Kit - Stored in a locked cabinet in the garage.

Resident & Staff Files - Located in cabinet in the garage.

Activities - Adequate supplies to include exercising, painting, and puzzles for resident's use.

Component III - Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Pre-licensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Applicant, Garrick Charlton and their signature below confirms receipt of these rights.