Facility Evaluation Report

Licensing Program Analysts (LPAs) Michael Bilger and Renee Campbell conducted an announced pre-licensing visit to this facility on 7-20-22 at 10:00am and was met by the Applicant, Michael Cooks . LPAs conducted a brief interview with the Applicant.

It was learned that this facility will be licensed as an Adult Residential Facility to serve up to 2 ambulatory clients and 2 non-ambulatory clients . This Applicant is also seeking vendorization from Valley Mountain Regional Center to accept and retain Level 4I clients . There were no clients present during today's pre-licensing visit. Tour of the facility was conducted.

Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. COVID Precautions in place including signage, PPE storage in place. Isolation rooms designated. LPA observed no obstruction of emergency exits. Exit signs in place as appropriate. Fire extinguisher in place at dining area off the kitchen and fully charged. Facility map indicating emergency exits posted in appropriate locations. Complaint poster is posted in appropriate location.

Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Adequate food supply observed.

Medication cabinet, located in staff office, was noted be locked and secured. First aid kit was observed to be present and contained all required components at this time.

A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time.

A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured at 105-120*F degrees.

Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. {Cont on 809C}