Facility Evaluation Report

Licensing Program Analyst (LPA) Perchui Milena Khurshudyan attempted to conducted a Pre-Licensing Inspection and met with the Staff/Caregiver Helen Dolorfino. Upon arrival LPA informed by S1 that the facility currently does not have an assigned Administrator. LPA explained the reason for the visit.

This is a Change of Ownership Application from facility #197605213 to # 197610503 to operate an Adult Residential Facility Level 2. A fire clearance was approved on 02/09/2024 for a maximum capacity of six (6) ambulatory adults.

LPA was unable to complete the Pre-Licensing Inspection at this time there was no Administrator assigned.

Exit interview conducted and a copy of this report was provided to the staff/caregiver.