Facility Evaluation Report

On 5/25/2022 at 1:25 PM, Licensing Program Analysts (LPAs) K. Nguyen, and L. Francisco arrived unannounced to conduct Pre-licensing Inspection. Upon arrival, LPAs met with Irenal Lakandula Administrator and explained the purpose of the visit. The facility's was approve for 4 clients fire clearance was approved for two ambulatory and 2 non-ambulatory clients. The facility currently is licensed as a group home with 4 existing clients. However, facility is in the process of changing facility type and inspection is being conducted as a new Adult Residential Care Facility (ARF) facility.

LPAs toured facility with Administrator including but not limited to 5 bedrooms, 1 staff room, 3 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 77 degrees F and hot water temperature was maintained at 107 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were observed. Fire extinguisher was last serviced on March 7, 2022.

LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.