Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced to conduct a Pre-Licensing Inspection and met with Administrator, Jenero Jefferson. LPA was initially greeted by staff, administrator arrived later

LPA toured facility with staff. Facility is a one story building with 4 client bedrooms. During the inspection 3 out of 4 clients were attending a day program away from the facility. At the facility LPA observed 1 staff and 1 client. Facility was clean and in good repair. LPA measured water temperature at 114.2 and 116.0 degrees F at two sinks available to clients which is within regulation. Client bedrooms were clean and had the appropriate furnishings. Bedrooms are personalized to suit each client's interests. Medications are stored in a locked medication closet. LPA and staff went over the medication administration record and medication pass for the morning of 05/17.

A fire extinguisher was observed in the kitchen, last inspected on 11/09/2021. Disaster drills are performed quarterly, last one was performed in January. Facility has an approved fire clearance for 4 ambulatory clients. Sufficient perishable and non-perishable food was observed in the kitchen. Sharps and cleaning supplies are kept in a locked closet in the living room. Smoke detectors and CO detectors were tested and operational.

LPA toured the backyard and observed scattered debris throughout. LPA provided guidance to make the outdoor area comfortable and furnished for outdoor use. LPA reviewed 2 staff records, both contained current CPR/First Aid training.

Component III reviewed with administrator. Exit interview conducted with administrator. LPA unable to print, report emailed to administrator. LPA will notify application unit so application process may proceed.