Facility Evaluation Report

02/22/2023 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct a Pre-Licensing visit for a re-location application. Prior to initiating the annual inspection, LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask, gloves. LPA met with licensee Jeremy Potter and explained the purpose of the visit.

Comp 3 was waived by licensee as they are currently licensed for four other facilities. Licensee plans to close one existing facility and will be relocating all clients into the new location.

The fire marshal has approved the fire safety inspection request. The facility is licensed for a total capacity of 4 ambulatory clients.

The inside of the facility was observed to be in good condition and repair. The facility has four (4) bedrooms, two (2) bathrooms, kitchen, dining room, living room, office, laundry room, and garage. Once the new location has been approved the furniture from the prior location will be moved to the new location.