Facility Evaluation Report

On 05/09/2022 at 9:20 am Licensing Program Analyst (LPA) T. White arrived announced to conduct a prelicensing inspection with applicant Tanneh Koayen for this adult residential facility application. Administrator Certification for Tanneh Koayen is #6030594735 that expires on 07/09/2023.

LPA conducted an inspection of facility including common areas, client bedrooms, bathrooms, kitchen, storage, and outside yard area. Requested capacity is 4 clients. The facility is clean and in good repair in areas toured. No hazards were noted in courtyard areas, hallways, doorways, etc. No equipment was stored in public areas. Fixtures and furniture all appear to be in good condition. Cleaning solutions are stored separately from food and are secured. There are no bodies of water on the premises. Smoke alarm was tested and operational. Fire extinguisher was in compliance and serviced June 11, 2022 and facility has carbon monoxide detectors.

Adequate number of bedrooms (4) for capacity requested. Facility has supply of bedding and towels. Furniture appears appropriate in bedrooms. There is adequate closet/drawer space available. there are adequate bathrooms for clients. Non-skid surfaces/mats were noted in the shower. Kitchen appears to be clean, well supplied with equipment. Facility has current staff files and adequate supply of forms. First aid kit was present at the facility. Laundry equipment present, working telephone, emergency lighting. Water temperature was measured at 118 degrees F.

LPA conducted Component III presentation.

Exit interview conducted and copy of this report was provided to applicant for signature. Report sent to the applications unit as this facility is ready for licensure.