Facility Evaluation Report

On 10/28/2024 at 1:20pm, Licensing Program Analysts (LPAs) Carol Fowler and David Do conducted an announced 2nd pre-licensing. LPA met with Diana Cheung, Administrator, and explained the purpose of the visit. The facility has an approved fire safety clearance for four (4) ambulatory clients and two (2) non-ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedroom 3 window coverings and bedroom 2 and 3 window screens, garage, back yard. The facility has a three (3) bedrooms downstairs and three (3) bedrooms upstairs which one will be occupied by staff and one by Administrator and a total of three (3) bathrooms. No bodies of water observed. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, bedding, and lighting. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 123.6 degrees Fahrenheit in shared clients' bathroom. Carbon monoxide and smoke detectors present and operable. Facility inspection matches the sketch that was provided.

Facility needs to correct the following by 11/11/2024:

· Purchase window screens for bedrooms 2 & 3.

Issues were noted during inspection. LPA observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted with Licensee and a copy of this report provided.