Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted an announced pre-licensed visit and met with Administrator Leilani Libang for the purpose of conducting a Pre-Licensing Inspection / Component III visit. This Pre-Licensing Inspection is due to change of ownership. The facility has an approved fire clearance to be licensed to serve five (5) bedridden clients. The facility is a single story home: 5 bedrooms, 2 bathrooms, dining/ living room, backyard with two locked tool sheds, and attached garage located in Claremont, CA.

The physical plant was toured inside and out alongside Leilani Libang. Pre-Licensed Inspection Tool was used.

· There are 2 bedrooms that currently occupied and are equipped with one bed, night-stand, chair, sufficient lighting, appropriate closet, drawer space and have the required bedding/linen. Remaining 3 bedrooms are missing bedding and one of the three is missing a bed.

· Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture.

· Sufficient supply of linens available to permit weekly changing are available.

· Sufficient personal hygiene supply available.

· The 2 bathrooms have working toilets/wash basin, and shower. One shower needs to be cleared of boxes and equipment, non-slip mat is also needed.

· Smoke Detectors and Carbon monoxide detectors are interconnected approved in the Fire Clearance.

· Two (2) Fire extinguishers observed and charged.

· Cleaning solutions and sharps need to be locked and stored separately.

· Kitchen cabinets, refrigerator/freezer , oven, microwave, dishwasher are in working condition, clean and sanitary.