Facility Evaluation Report

On 9/15/2022 at 10:10AM Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct Pre-licensing Inspection. Upon arrival, LPA met with Fernando Fernandez, Administrator and Angelina Erasquin, Applicants and explained the purpose of the visit.

The facility was approved for 6 clients; fire clearance was approved for four (4) ambulatory and 2 non-ambulatory clients. No bedridden approval.

LPA toured facility with Applicant including but not limited to 3 bedrooms, 1 office room, 2.5 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 120 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were observed. Two fire extinguishers are brand new purchased on May 22, 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.