Facility Evaluation Report

On 4/25/2022 at 11:30 AM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct Pre-licensing Inspection. Upon arrival, LPAs met with Care Staff Ronald Corum and explained the purpose of the visit. Administrator, Angelita Casipit later arrived at 11:50 AM. The facility's fire clearance was approved for six ambulatory clients. The facility currently is licensed as a group home with 4 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 with Care Staff and Administrator including but not limited to 3 bedrooms, 1 staff room, 3 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 68 degrees F and hot water temperature was maintained at 106 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 12/2/2021.

Prior to licensure, the following shall be corrected by May 2, 2022

-Repair light switch in client's bathroom

-Equip each client's room with bedside table

Exit interview conducted and a copy of this report provided. LPA will return to follow-up and complete COMP III at a later time.