Facility Evaluation Report

On 01/27/25, Licensing Program Analysts (LPAs) L. Salazar and M. Medina arrived to the facility for an announced Pre-licensing (Change of Location) inspection. LPA met with Licensee and Administrator. No residents were present at the time of LPA's visit.

LPA toured of the facility inside and out with Administrator. Facility is observed to be a 3 bedroom / 3 bathroom house. Common areas were observed to be clean, spacious. Blue tape was outlined in the areas where the furniture will be placed on the day of the relocation. Facility was well-lit throughout. Carbon monoxide and smoke alarm detectors were installed and operational. Cleaning and chemical supplies were observed locked in the garage. Facility’s temperature read 68 degrees F. Fire extinguisher observed in the kitchen with a service date of 01/14/24. Washer and dryer observed in the laundry room with additional storage space available. Doors and passageways are clear and free from obstruction throughout the home. A fully gated pool was observed to be locked. Patio was observed to be covered, with lights installed. A separate covered seating area was observed for smoking.

Resident’s bedrooms were observed to be adequately furnished with bed, night stand, drawer space, chair and adequate lighting. Mattresses and linen were in good condition. Extra linen are available in the hallway closet. Hand soap, paper towels, and trash cans with tight fitting lids were observed. Water temperature measured at 107 degrees F.

First aid kit observed to have required items. Once relocated, medications will be locked in the hallway closet. Appliances observed to be in working order. LPAs observed food storage and preparation areas to be clean and appropriate for food preparation. A sample menu of 7 days was observed posted. Emergency disaster and Infection control plan were observed to be complete.

Component III was completed, an exit interview was conducted with Licensee and Administrator. LPA Salazar will contact Central Applications Bureau and advise the facility is ready for Change of Location licensing.