Facility Evaluation Report

At 9:00AM Licensing Program Analyst (LPA), Antonia Alvizar-Ettima conducted an announced Pre-Licensing visit to the above facility and met with Licensee.

Fire Clearance was approved on 01/11/2024 for a maximum capacity of six (6) Non-Ambulatory residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building located in a residential community. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following:

KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, dish washer, microwave oven and sink. At approximately 9:20AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. Full charged Fire Extinguisher with receipt dated 07/07/23.

LAUNDRY ROOM: The laundry room is located next to dinning area with a locked door. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision.

BEDROOMS: There are five (5) bedrooms designated for client use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting.

BATHROOMS: LPA observed all bathrooms clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat. Water temperature was between 116.1 -118.2 °F which is within regulation.