Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon conducted a Pre-licensing and Component III orientation visit. LPA Calderon met with Applicant / Administrator Christopher Bundallian and Marissa Mashburn.

Application was submitted for an initial license of Adult Residential Facility for ages 18-59. Fire clearance states approved for a total capacity of: four (4), (2) Ambulatory , (1) Non-Ambulatory , and one (1) bedridden. Bedridden approved for Bedroom #1 can also be used for for a non-ambulatory resident. Facility approved Dementia care plan. Applicant stated Hospice Wavier was submitted to CAB for approval, pending confirmation, LPA will reach out to CAB Analyst.

LPA alongside with Christopher Bundallian and Marissa Mashburn. Physical plant tour conducted a walk-through of the entire facility, which included the outside perimeters of the property. The home is located in a residential area within the city limits of Atresia, CA and consists of a single story building, 4 bedrooms (1 staff room), 3 bathrooms, a living room, dining room/ kitchen, back yard and an attached garage.

Facility was observed to be clean and in good repair. House temperature was between 68 degrees and 85 degrees Fahrenheit. All window screens were clean and in good repair. There was appropriate lighting in the facility and in each room. Indoor and outdoor passageways free of obstructions. Ramps, pass ways and porch areas are well-lit and were free of potential hazard. The physical plant is consistent with the submitted facility sketch/floor plan.

Kitchen and dining room floors were observed to be clean, sanitary and odorless. Trash can had tight fitting covers.