Facility Evaluation Report

At 12:00pm on 10/24/2024, Licensing Program Analyst (LPA) Jeffries arrived at the pre scheduled time to conduct a pre-licensing inspection. This is a pre licensing with a change of address for this licensee and COMP III is waved.

The facility is a 4 bedroom, 2 bathroom, Kitchen, dining room, living room, laundry is in the garage which is separated by door with a standard lock. The master bedroom and on suite bathroom (#1) is designated as a staff bedroom and bathroom. Bedroom #2 is also designated as a staff room. The other 2 bedrooms will be double for a total for 4 clients who will all share bathroom (#2). Water temperature was tested and within regulation range of 105*-120* (f). There is liquid soap and paper towels in the bathrooms. Client bedrooms have sufficient storage and appropriate furnishing a per regulation standards with chair and light for reading. Facility has ample and appropriate linins for clients. LPA observed and reviewed Emergency Disaster Plan, and Infection Control Plan. LPA observed fire clearance singed and dated on 06/13/2024 by San Miguel Fire Department for 4 ambulatory clients. LPA observed a working, primed in the green, fire extinguisher. LPA observed and tested smoke alarms throughout the facility and a working carbon monoxide detector. Medications will be locked and stored in upper cabinet in the garage. LPA observed a full first aid kit. LPA observed at least 2 days of perishable foods and at least 7 days of non-perishable foods on hand for 4 clients and staff. LPA observed emergency water stored in the garage. The facility was clean and in good repair. All exit are free and clear of obstacles and debris. LPA noted no deficiencies during the walk through inspection.

Licensee and LPA conducted a full review of the pre licensing care tools modules and found no decencies.

Exit interview, no deficiencies, report read, and report provided.