Facility Evaluation Report

At 11:30 a.m. on this day, August 15, 2024, Licensing Program Analyst (LPA) Delmundo conducted an announced pre-licensing inspection and met with Ellen Biyok, applicant-administrator. License application is for change of location for six (6) total capacity, of which 2 may be non-ambulatory . Fire clearance was granted on July 22, 2024.

Applicant submitted the LIC610D Emergency Disaster Plan to Central Application Bureau (CAB) analyst; however, corrected copy showing one of the shelter locations in city outside of Hayward obtained by LPA on this day.

LPA toured the facility inside out with applicant-administrator. LPA inspected the living room, kitchen, bedrooms, bathrooms, staff room, front, side and backyard. Bedrooms were observed appropriately furnished with adequate lighting and drawers. The facility has sufficient towels and linens. Supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed adequate for residents' use. There’s 7 days supplies of non-perishables and 2 days of perishables. Facility is equipped with refrigerator, microwave and dishwasher. Central storage for medications, cabinet for cleaning supplies and cabinets for residents and staff files were observed with locks.

First aid kit inspected and observed complete with manual. Fire extinguisher was observed fully charge with tag showed serviced 9/25/23. Facility has carbon monoxide and smoke detectors that were tested and observed functional.

-at 11:30 a.m., front yard with uneven ground surface.

-at 11:35 a.m., fireplace not properly screened.