Facility Evaluation Report

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility announced to conduct a pre-licensing visit. LPA met with Licensee Zully Six and Paul Six.

LPA observed zero residents in careLPA and Licensee/Administrator toured the facility to ensure compliance of Title 22 regulation. LPA toured common areas, dining room, bathrooms (2), bedrooms (4), and exterior plant. LPAs observed the area where the staff and resident files will be locked and readily available for review. Emergency disaster plan and necessary signage posted and available. LPAs observed no obstruction of emergency exits inside or outside of facility.

Resident bedrooms observed to have necessary furniture. Resident bedrooms are furnished with a bed, chair, night stand, personal dresser, and extra closet space. All emergency exits have appropriate signage. Cleaning supplies were secured and locked in the storage space. LPA observed smoke detectors and carbon monoxide detectors were noted and functioning properly. LPA Valerio and Administrator observed the hot water temperature in bathroom to be within regulatory range. LPA observed area where food supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days will be maintained on the premises. LPA Valerio observed fire extinguisher in place outside of kitchen area and fully charged. The exterior plant has a gardening area, locked sheds, and a place for outdoor activities or visits. There is a fenced pool, however, it is not in use and no water was observed inside the pool.

Per California Code of Regulations (CCR) - no deficiencies were observed today. Pre-Licensing is complete and this facility has no deficiencies. Comp III was completed at the time of the visit. LPA Valerio to inform the CAB department that the visit has been completed. An exit interview was held, and a copy of the report was provided.