Facility Evaluation Report

12/13/2023 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct their scheduled pre-licensing inspection. LPA met with Dave & Gail Mason and explained the purpose of the visit. This is an existing facility, the licensee changed the corporate structure which required this prelicensing visit.

LPA toured the facility inside and out. The inside of the facility was observed to be in good condition and repair. The facility has received fire clearance for four (4) ambulatory clients. The facility has three (3) client bedrooms, one (1) staff room, and one (1) bathroom. LPA observed a large dining room table with 6 chairs in the dining room. LPA observed a couch and loveseat in the common area.

Food storage meets Title 22 regulation requirements. Plates, utensils, pots, and pans were in place during the inspection. Dishwasher, stove, microwave, and refrigerator were all present and working.

The facility has (1) fully charged fire extinguisher which has been inspected by the fire marshal. LPA observed smoke alarms and carbon monoxide detectors fully functioning.

Bedrooms were observed to have furniture as required by Title 22 Regulations. All beds were made up with linens and bedspreads. The facility has a linen closet which contains towels and face cloths. Bathroom was observed to be in good repair.

Storage and lighting are adequate in the home. Medications are stored in a locked cabinet. Cleaning supplies and toxins are locked up in a cabinet.. Also locked in the kitchen are knives. Washer and dryer observed in place and ready for use.

There is an office space where client and staff files are stored in a locked cabinet.

The back yard has shade trees and shade structure with a table, and chairs for the clients to use.

The applicant has passed the pre-licensing portion of the application process. LPA will contact the Central Application Bureau.

Exit Interview and copy of report was provided to the administrators.