Facility Evaluation Report

On 01/02/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak met with Licensee Estefania Perez to conduct an announced Pre-Licensing visit.

The facility has a fire clearance for four (4) ambulatory residents. The Licensee has a current administrator certification (#6062755735) with an expiration date of 08/07/24.

LPA and Licensee conducted a tour of the interior and exterior of the facility to ensure compliance with Title 22 regulations. Areas toured include but are not limited to, four (4) private residents bedrooms, two (2) bathrooms, common areas, kitchen, dinning room, laundry area, staff quarters and the backyard.

All bedrooms had furnishings which include, a bed for each resident, night-stand, lamp, and storage space.

LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors to be operational. Fire extinguisher and first aid kit are maintained and ready for emergency use. Water temperature was observed over 125 degrees Fahrenheit. Warning signs are posted

It was advised Licensee should store the knives in the kitchen in a locked cabinet so it will be easily accessible to a caregiver when they are cooking. Licensee is going to send LPA Ratajczak a picture of personal rights and Administrator certification once posted.

Licensee agrees to notify LPA once first consumer is admitted . LPA Ratajczak provided Licensee with LIC311C, records to be maintained at the facility.

Comp III completed. No deficiencies observed. LPA Ratajczak will notify Centralized Application Bureau (CAB) of inspection completion.

Exit interview conducted and a copy of the report was provided .