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. This is the 2 nd Pre-Licensing visit LPA has done thus far for this new 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 is a locked storage area that is centrally located for medication.

· Cleaning supplies are kept separate from food and located in a locked cabinet under the kitchen sink.

· Facility walls, ceilings, floors, window screens and areas around the facility are clean and in good repair.

· Fire extinguishers and smoke detectors operate properly.

· Doors and passageways are free of obstruction.

· There are no pools/bodies of water at the facility.

· Facility does not have firearms on premises.