Facility Evaluation Report

Licensing Program Analyst (LPA) KaSandra Lopez conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Akosua Arthur. This application is a change of ownership. The home is currently licensed as Arthur Family Home 565850065. The home will be vendored by Tri-Counties Regional Center as a level II home. Component III was completed during today's inspection.

At 9:25 AM, a physical plant tour was conducted inside and out. The facility is a two story home. An approved fire clearance was received, clearing the facility for six ambulatory residents. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linens. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture. In addition, no bedroom was used as a passageway to another room, bath or toilet. The master bedroom is designated as a staff room. All rooms were free of odors. All window screens were clean and maintained in good repair.

There is one common bathroom on the first floor and second common bathroom on the second floor. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records are stored in a locked cabinet which is currently located in the office. Medications and cleaning supplies are also centrally stored in locked cabinets in the office The first aid supplies were complete, including a thermometer and a current version of a first aid manual.

Kitchen knives are stored in a locked box in the pantry. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. No flies or other vermin were observed. Report continued on LIC 809-C.