Facility Evaluation Report

An unannounced Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator (Admin) Maria Perez & Direct Service Professional (DSP) Gwena Kane.

This is an Adult Residentia l Enhanced Behavioral Supports Home. Facility has specific protocols regarding staff & visitors. Additional safety protocols & checklists in place prior to going onto floor in residential portion of facility.

Physical plant toured. 2 day supply of perishable & 7 day supply of Non perishable food on the premises. Dining & living rooms have required seating & lighting. Client bedrooms toured. Bedrooms have required furnishings & lighting. Bathroom used by client(s) toured. Bathroom appeared to be clean with no unpleasant odors. Locked storage observed for cleaning products & other hazardous items making them inaccessible to clients. Hot water tested & measured @ 115 degrees F.

Interior & exterior passageways observed to be clear with no obstructions.

Facility appeared to be clean with no unpleasant odors. Medications observed to be locked & to be organized. Smoke detectors operational. Fire Extinguisher service date: 12/3/2022.

Client & staff records to be reviewed at a future date.

Exit interview held with Admin. Report provided.