On 10/27/2022 an application was submitted to CCLD, for a change of location license for an Adult Residential Facility to serve adults ages range from 18 through 59. The requested capacity is for 4 clients of which 2 may be non-ambulatory clients. The facility is a 5 bedroom, 3 bathroom, 1 story house.

LPA Leon conducted a review of the Physical Plant, Bedrooms, Bathrooms, Supplies, Food Service, Medications, Records, Administration, Activities, Pre-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, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. There are no pools or bodies of water on-site. There are locked storage areas for poisons, chemicals and sharps. All window screens are clean and in good repair. Facility maintains a comfortable temperature at 72.5 degrees F. The facility has central air conditioning. Inclines, ramps, open porches, and areas of potential hazard are well-lit. The facility uses the first bedroom as the private office along with an attached bathroom, all inaccessible to clients. Smoke alarms and carbon monoxide operate properly.

See LIC809-C

Halls, stairways, unfinished attics, 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) night stand per client.

BATHROOMS

There are two (2) toilets and two (2) washbasins available for client use, family, and personnel. There are two (2) showers, one of which may also be used as a bathtub per ten (10) clients, family, and personnel. Hot water temperature is 119.1 degrees F in kitchen and 108.1 degrees F in bathroom number three (3). All bathrooms are located near client bedrooms. There are night-lights in the hallways outside non-private bathrooms.

SUPPLIES

There are client personal hygiene supplies to include feminine napkins, 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 kept at 0 degrees F. Refrigerator is a maximum of 45 degrees F. 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.

See LIC 809-C

There is confidential storage of personnel records at the facility. There is 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 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, 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. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries are present. Vehicles used to transport clients are in safe operating condition.

PRE-LICENSING CHECKLIST

Completed by licensee and reviewed by LPA.

See LIC 809-C

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

During the pre-licensing inspection, there were no deficiencies cited.

An exit interview was conducted, and a hard copy of this report has been provided to Olakemi Moses.

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.