On 06/14/2024, an application for a Change of Location (CHOL) of a currently operating Adult Day Program (ADP) was received by Community Care Licensing (CCL). On 07/26/2024, an approved fire clearance was granted to the facility after fire inspection and repair by Licensee of two (2) Fire Department violations. These violations were to have the address identification on the east side of the physical plant of the facility and repair/replacement of backup emergency lighting in common areas of the facility. The facility has an approved capacity of Fifteen (55) clients, forty (40) may be ambulatory while (15) may be non-ambulatory. Operating hours of this ADP facility are Monday through Friday from 6:30am to 3:30pm. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The physical plant of the facility consists of the majority of the first story of a two (2) story building. The facility is single story with a number of rooms/offices in the common areas of the facility not used by the ADP. These areas have no access for facility Staff or clients of the ADP. The facility has multiple common area rooms, a food storage/preparation area, Client restrooms, Staff areas, and storage areas. Outdoor activity space is provided by the facility which is free of hazards and will be enclosed by fencing with shaded rest areas and furniture for clients.

COMMON AREAS: At the time of the visit, the facility was observed by LPA to be in good condition with no observable damage to the physical plant of the facility nor any observable hazards to clients. During the visit, minor internet wiring maintenance was being conducted on various portions of the building housing the physical plant of the facility. The facility has a main entrance lobby area that will have infection control screening and sign in procedures. There are multiple Staff office rooms with desks, computers, storage cabinets, etc. The facility is furnished with a smoke alarm/fire alarm system. Continued on 809-C

FOOD PREPARATION AREA/LAUNDRY AREA: The facility has a designated food preparation/service room although this is an Adult Day Program (ADP) and does not utilize a main kitchen for clients of the facility. The designated food preparation/service room will serve as the snack area for clients during scheduled business hours. This area has a microwave, toaster oven, refrigerator, and various utensils/items for the preparation of snacks. All appliances were in operable condition and looked clean/in good repair. The licensee will comply with CCL regulations regarding knives/sharp instruments being stored in locked drawers inaccessible to clients. The LPA observed storage areas within the food service area for a sufficient supply of perishable and non-perishable food. The hot water temperature was measured in the food service area at an appropriate temperature as per the regulation(s). The food preparation/service area was observed by LPA to be clean and sanitary. No toxic substances will be stored in any food preparation or storage area, and all cleaning supplies for the food service and preparation area will be kept in a separate area than the food supplies. The freezer and refrigerator were both the appropriate temperate Fahrenheit for the storage of food and prevention of spoiling. There is enough tableware and utensils for all clients living in the facility, and enough equipment for the storage, preparation, and service of food. The previous physical plant location of the facility contained a laundry section/area, with a washer and dryer being located adjacent to the to the food preparation area. This physical plant location inspected by LPA today does not contain a washer and dryer and LPA was told by facility representatives that the appliances will not be utilized at this location. Continued on 809-C

RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There are two (2) client restrooms in the common areas of the facility that included soap, paper towels, required postings, and clean trashcans with closed lids. One (1) restroom is labeled "Men" for the male clients of the facility, and one (1) restroom is labeled "Women" for the female clients of the facility. Both restrooms were observed by LPA to be "public" style restrooms with multiple toilets separated by partition and self latching door for client privacy. The restrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees Fahrenheit. There are an adequate number of toilets per client in the facility. Nightlights are not necessary to be installed as the clients are only in the facility from 6:30am-3:30pm Monday-Friday. All toilets and hand washing areas will be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences will be provided by the ADP to accommodate any physically handicapped clients who need such items.

RECORDS/MEDICATIONS: Personnel records are maintained digitally by Licensee within a software system utilized for multiple facilities. The program administrator meets the qualifications as specified in Title 22 regulations. Additionally, the program administrator receives and documents continuing education each year. On 08/07/2024, a compliance reivew and association of the facility administrator was conducted by Community Care Licensing (CCL). The facility will comply with CCL standards for health screening, TB clearance, staff training, criminal background clearance and transfer requests. Client records including Admission agreements and Needs and Services plan will be maintained for each Client and/or their authorized representative. Continued on 809-C

INFECTION CONTROL: Upon entry, the facility has a central entry point which will be used for symptom screening and a sanitation station. Facility staff will keep up signs that promote good hand hygiene and symptoms of COVID. Licensee has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. Cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate.

FACILITY DOCUMENTATION: The previous physical plant location of the facility has postings throughout the facility, including emergency exit plans with necessary telephone numbers which will be replicated by the new physical plant location. The Licensee has copies of facility documentation such as the Fire Department Clearance, Personnel Report, Plan of Operation, Emergency Disaster Plan, Facility Infection Control Plan/Mitigation Plan, Evacuation Procedures, Personal Rights of Clients with Developmental Disabilities, and a Facility Sketch. Provider Information Notices are available and able to be presented to Staff, clients, visitors, and accessible to LPA. Facility documentation will be prominently posted in areas accessible to clients and their visitors.

COMPONENT III ORIENTATION: A Component III Orientation was waived by Community Care Licensing (CCL) on 08/08/2024 due to this licensee already having multiple Adult Day Programs (ADPs).

This report will be sent to the Centralized Application Bureau (CAB). Notification by the CAB Analyst will occur when the license has been approved. Operation at this location is not allowed until notified that license has been approved by the CAB Analyst.

Pre-Licensing is complete, and this facility has no deficiencies.

Exit interview conducted. Copy of this report provided to the facility.