Facility Evaluation Report

On 10/03/23, Licensing Program Analyst (LPA) M. Medina conducted an announced Pre-licensing inspection. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensees Tyson and Adonica Vickers. LPA toured the facility with Licensee. The facility is 4 bedrooms and 3 bathrooms home. Fire clearance was granted for 6 non-ambulatory residents.

Common areas were furnished and had adequate seating and lighting available. All bedrooms were observed to have required furnishings. Kitchen was toured and observed to have dishes, plate, and utensils. Facility has 7-day supply of non-perishable food available as of date of inspection. Knives and medication will be locked and secured in hall closet. Cleaning supplies and chemicals will be locked and secured in garage. Fire extinguisher present with a purchase date of 7/12/23. Smoke detectors and carbon monoxide detectors were observed to be operational during this inspection. Water temperature measured at 107 degrees F. Facility has a working telephone of (661) 695-6002.

Outside of facility toured. Exits open free of obstruction. Pool is surrounded by a locked and secured gate and inaccessible to residents.

Component III conducted during pre-licensing inspection.

The following items must be completed prior to applicant meeting all pre-licensing requirements 1) All personal items must be removed from home 2) All yard tools must be locked and secured 3) All items near backyard exit must be removed.

LPA will conduct follow up inspection visit when corrections have been completed. Exit interview conducted and a copy of report provided for facility records.