Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection. LPA met with Gemma Rodriguez, applicant, and Ulysis Rodriguez, administrator. This is a new application applying for Adult Residential Facility to serve for ages 18 to 59 years. The requested capacity is four (4) clients. The facility is located in a residential neighborhood. Administrator certificate is current and expiration date is 10/01/2022.

Its fire clearance is approved for three (3) ambulatory clients and one (1) non-ambulatory client. Bedroom #4 is for non-ambulatory client. This facility is granted a fire clearance on July 29, 2021.

The facility is a single-family house. There are four (4) client bedrooms, two (2) bathrooms, kitchen, dining area near the kitchen, living room with a TV, laundry room, and backyard with a patio.

Bedrooms have a nightstand, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage. Bedroom #4 for ambulatory clients are accommodated

Toilet, wash basin, and shower in bathroom are operable. Grab bars are maintained for bathtub.

Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Dishwasher in kitchen properly installed and functioning. Stove is operable. Water temperature tested at 115.5 degrees Fahrenheit in kitchen sink which was in compliance with the regulation. (-Continued LIC 809 C -)