Facility Evaluation Report

At 8:00am on 06/11/2024, Licensing Program Analyst (LPA) Jeffries arrived at the pre scheduled time to conduct the Pre Licensing inspection of the facility. LPA reviewed the Pre Licensing packet and observed a STD-850 (fire clearance) singed and dated on 08/29/2023 for 4 ambulatory residents. LPA observed and reviewed Infection Control Plan, Emergency Disaster Plan, and Plan of Operation included with the Pre- Licensing packet.

Licensee and LPA conducted an full tour of the facility inside and outside. LPA noted that this is a 3 bedroom, two bathroom facility with living room, dining room, kitchen, and attached 3 car garage where the washer and dryer are located. There is a back side yard on the north side of the facility and a large deck porch with table and umbrella for shade. LPA noted that the clients will share one bathroom and will be double occupancy in two of the three rooms. The master bedroom will be a live-in staff room with on suite bathroom. LPA noted that all rooms have bedding, linin, and furniture per regulations. LPA noted that there are battery operated smoke detectors in each room and a carbon monoxide detector in the hallway all tested and win working conduction. LPA noted that all hallways, passage ways and doors were free and clear of obstacle. LPA noted that all appliances were operational and in good working condition. LPA noted that the sharps and chemicals were locked in the garage above the washer and dryer. LPA noted that the facility has a first aide kit with all regulated items within the first aide kit. LPA noted that the facility is using a lock box for medication that will be located in the locked garage area in the same cabinet as the sharps and chemicals. LPA noted that the facility is clean and in good repair. LPA noted that all required posting are posted in a conspicuous location in the central hallway. LPA noted no issues, or deficiencies during the full walk through tour of this facility.

Licensee and LPA conducted a full read and review of the Pre Licensing Care tools modules. LPA noted that there were no technical, deficiencies, citations, or issues with the full care tools read and review.

Exit interview, report read, and report provided.