On 03/22/22 an application was submitted to CCLD, for Initial license for an Adult Residential Facility to serve adults age range 18 through 59. The requested capacity is for (2) clients of which (0) may be non -Ambulatory. The facility is a 3 bedrooms, 2 bathrooms, 1 story house.

LPAs and LPM 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 no 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 obstruction. All window screens are clean and in good repair. Facility temperature is between 68 degrees and 85 degrees. Fireplaces and open-faced heaters are accessible to clients. Stairways, inclines, ramps, open porches, and areas of potential hazard are well-lit. Fire Alarms and Smoke alarms operate properly. Carbon monoxide detectors operate properly.

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 and assistive devices such as wheelchairs, walkers, or oxygen equipment. 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. Mattresses and pillows are flame-retardant. 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 and at least one (1) nigh-stand per two (2) clients. If applicable, resident bedrooms with security bars on windows/doors have at least one (1) window/door in the bedroom with an approved safety release to allow emergency evacuation.

BATHROOMS

There is at least one (1) toilet and washbasin per six (6) clients, family, and personnel. There is at least one (1) shower or bathtub per ten (10) clients, family, and personnel. Hot water temperature is between 140-150 degrees Fahrenheit. Bathroom is located near client bedrooms. There are night-lights in the hallways outside non-private bathrooms.

SUPPLIES

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 not 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.

There is no confidential storage of personnel records at the facility. There is no confidential storage of client records at the facility.

ADMINISTRATION

The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings.

ACTIVITIES

There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to clients for visitors. There are no activity supplies to include newspapers, magazines, and a variety of reading material.

MISCELLANEOUS

There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, (no) thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. For facilities of 16 or more capacity, there is a designated laundry space. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. Vehicles used to transport clients are in safe operating condition.

PRE-LICENSING CHECKLIST

Completed by licensee and reviewed by LPA.

COMPONENT III

Provided via video conference, information was provided about how to operate the facility within substantial compliance.

1. There is no locked centralized storage area for client medications.

2. Fireplaces and open-faced heaters are accessible to clients.

3. Hot water temperature is between 140-150 degrees Fahrenheit.

4. A seven (7) day supply of non-perishable food is not present.

5. There is no confidential storage of personnel records at the facility. There is no confidential storage of client records at the facility.

6. There are no activity supplies to include newspapers, magazines, and a variety of reading material.

7. There are first-aid supplies to include thermometer,

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

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