Facility Evaluation Report

On 03/25/22 at 12:00pm, Licensing Program Analyst LPA/ Susan Campos conducted an announced visit to the facility for purpose of a pre-licensing evaluation. The LPA was allowed entrance into the facility by Administrator Ashley Acosta. The LPA and Ms. Acosta, conducted a walk through of the facility for the pre-license inspection.

An application for change of ownership was submitted to CCLD on 1/26/22, for a change of ownership license application for an Adult Residential Facility to serve Developmentally Disable Adults, ages ranging from 18 to 59 years. The applicant requested for a capacity for four (4) ambulatory individuals. Currently, the facility has 3 clients living in the facility. The home is vendorized level 4I through the Harbor Regional Center.

The home consists of 6 bedrooms and 4 bathrooms (3 client bedrooms, 2 full bathrooms, and 3 staff rooms, and 2 staff bathroom). Facility is a two story house in a residential neighborhood. The facility is a tan stucco structure with a floor plan which includes: living room, dining room, kitchen, family den, activity/ theater/ laundry/ storage room. The interior has lighting throughout. The living area has non-operational working fireplace. The living area also included (1) sofa/ (2) Accent chairs and a side table, cabinet and coffee table. The kitchen has granite counter tops with refrigerator, stove/ microwave, and on counter toaster, coffee machine and blender. Den/ family room has large screen television, with (2) sofas, cabinets, and recreational games, coffee table. Activity/ Theater room has two sofas, large projection screen, table and chairs, sink, counter, refrigerator, and storage area including emergency food and water. During the visit, LPA noticed passageways, walkways steps and patios are free from obstructions. LPA observed a covered back yard deck with patio cover table and chairs, and a second patio area with table, chairs and umbrella.