Facility Evaluation Report

On 11/05/2021 at 12:25 PM, Licensing Program Analysts (LPAs) C. Lin and L. Francisco arrived unannounced to conduct Pre-licensing required inspection. LPAs met with Administrator, Maureen Lee and explained the purpose of the visit. Fire clearance is approve for ambulatory only. The facility currently is licensed as a group home with 3 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 including but not limited to 3 clients' bedrooms, 1 staff room, 2 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 70 degrees F and hot water temperature was maintained at 116.7 degrees F. First-aid kits were observed to be completed. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 6/2/2021.

Component III is waived. No issues noted during inspection. 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.