On 05/23/2022 an application was submitted to CCLD, for a change of ownership for an Adult Residential Facility: Enhanced Behavioral Support Home to serve developmentally disable adults age range 18 through 59. The requested capacity is for three non-ambulatory clients. The facility is a three bedroom, two bathroom, one story house.

LPA Cloyd conducted a review of the Physical Plant, Bedrooms, Bathrooms, Supplies, Food Service, Medications, Records, Administration, Activities, Pe-Licensing Checklist and Component III Orientation.

MEDICATIONS

There is a locked centralized storage area for client medications.

PHYSICAL PLANT

Facility is clean, sanitary, and in good repair. Protective devices are in place to include nonslip material on rugs. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions, well-lit, and equipped with sturdy hand railings. All window screens are clean and in good repair. Facility temperature is between 68 degrees and 85 degrees. Fire Alarms and Smoke alarms operate properly. Carbon monoxide detectors operate properly.
LIC-809C.

Halls, stairways, unfinished attics or basements, garages, storage areas, and sheds, or similar detached buildings are not being used as client bedrooms. Client bedrooms are large enough to allow for easy passage and to accommodate furniture. No client bedroom is a passageway to another room, bath or toilet. There is a bed for each client with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. There is dresser and closet space for each client that includes at least two (2) drawers or eight (8) cubic feet of dresser space per client. There is a chair and lamp for each client.

BATHROOMS

Two bathroom are located near client bedrooms.

SUPPLIES

There are client personal hygiene supplies that includes soap, toothpaste, toilet paper, and comb. There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths.

FOOD SERVICE

Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0 degrees Fahrenheit. Refrigerator is a maximum of 45 degrees Fahrenheit. A seven (7) day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean.

LIC-809C.

There is confidential storage of personnel records at the facility. There is confidential storage of client records at the facility.

ADMINISTRATION

The emergency disaster and infection control plans are posted in the staff’s break room.

ACTIVITIES

There is an outdoor activity space with a shaded area and furnished for outdoor use. There is one room designated for activity supplies such as games and arts & crafts.

MISCELLANEOUS

There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is an operating telephone. Emergency lighting, generator, and supplies to include flashlights with batteries are on-site. Vehicles used to transport clients are in safe operating condition.

PRE-LICENSING CHECKLIST

Completed by licensee and reviewed by LPA.

COMPONENT III

Provided in-person. Information was provided about how to operate the facility within substantial compliance.

An exit interview was conducted, and a hard copy of this report has been furnished to the Administrator Mary Harris.

Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to the applicant.