Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson arrived announced to complete a pre licensing inspection. LPA met with Pam Survine.

Currently there are no clients at the facility. Fire clearance was granted on 3/23/22 for 4 ambulatory clients.

Facility was inspected both indoors and outdoors. LPA inspected proposed bedrooms, bathrooms, kitchen, garage, and common areas. Outdoor exits are clear and accessible. There are 2 floors to this facility. 5 resident bedrooms, a staff room and 4 and 1/2 bathrooms were observed.

Hot water temperature was measured at 116.5 degrees. Smoke detectors and carbon monoxide detectors were checked and operational. Fire extinguisher indicator revealed a full charge. Kitchen is clean sanitary, and in good repair. There will be locked areas for cleaning supplies, sharps, medications and toxins.

Component III was completed. The land line is (209) 323-4718

The applicant has passed the pre-licensing inspection.

LPA will notify the Central Applications Unit.