Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct an annual Required-1 year inspection and met with Care staff, Jonathan Germany. LPA spoke with Administrator, Lamaya Lee by phone. Administrator was not available during this visit. This facility is licensed for 6 ambulatory clients.

LPA toured facility and grounds with Jonathan Germany and observed the home to be clean at a comfortable temperature with all exits free from obstruction.

Smoke detectors and carbon monoxide detectors are operational. The fire extinguisher located in the kitchen was observed charged. Bedrooms were observed with the required furnishings, 1 bedroom was not set up, but there was a bed an additional items to set up the room.

LPA went over requirements once they get their first client, at this time individual living in the home, identified as i1, previously provided LPA with their ID and i1 is fingerprint cleared and associated to this facility.

Facility understands they need to notify LPA once their first client moves in.

LPA discussed their Emergency Disaster Plan and Infection Control Plan.

Licensee/Administrator to submit the current following documents by 8/21/2023:

· LIC 308 Designation of Facility Responsibility

· LIC 400 Affidavit Regarding Client/Resident Cash Resources

· LIC 9020 Register of Facility Residents

Infection Control Plan of Operation (If changes)

No deficiencies cited during today's inspection.