Facility Evaluation Report

On 08/22/25 Licensing Program Analyst (LPA) Javina George made an unannounced to the facility to the facility to conduct a 1 year required visit. LPA was greeted and granted entry by Direct Support Professional (DSP) Barthelemy Delva, where LPA explained the purpose of the visit. The administrator was unavailable to come to the facility as there are currently in a training. The facility is licensed to serve four (4) ambulatory clients. Below are the observations made during today's inspection:

The facility was observed to be clean and free of any obstructions. The facility is a single story structure consisting of (3) bedrooms and (2) bathrooms, laundry room, office area, garage, den, dining area and backyard.

All staff files reviewed were observed to be staff that have obtained criminal record clearance and to be associated to the facility. The files are electronic and staff present did not have access, therefore LPA was unable to review training received. Client files, did not have the required paperwork such as admissions agreement. The Personal and Incidental funds were not reviewed as the staff present did not have access. LPA provided a copy of LIC311C- Records to be maintained at the facility.

The facility food supply was observed to be sufficient as there was a 2 day supply of perishable and a 7 day supply of non perishable food items. The facility was observed to utilize video surveillance in the common area as well as at the entrance of the facility. The facility sketch will be updated, as well as an addendum to the program statement and the clients will sign an acknowledgment stating that there are aware video surveillance is being utilized at the facility. Due to the department by 5pm on or before 08/28/25.