Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong, conducted an announced visit to the facility for purpose of a Pre-licensing evaluation. LPA met with Initial Administrator Jason Smith and Potential Administrator Melissa Allen-Zhang who assisted with today's visit.

An application was submitted to CCLD on 09/16/2022, for initial license for an Adult Residential Facility to serve Developmentally Disabled Adults for ages 18 to 59 years, The requested capacity is for 3 non-ambulatory and 1 ambulatory.

During today's visit, LPA Wong utilized the Compliance and Regulatory Enforcement (CARE) tools for the pre-licensing visit today :

1. Physical Environmental and Safety: The facility is a single story house and is located in a residential neighborhood area. The facility includes living room, dining area, kitchen, four clients bedrooms, three bathrooms and an attached garage. The passageways, walkways, driveways, steps and patios are free from obstructions. All client bedrooms have one bed, one chair, night stand, drawer and sufficient closet space and lighting. Bedroom#2, #3 and #4 are for non-ambulatory clients. All bathrooms have a working toilet, wash basin and bath tub/shower. Bathroom#2 will accommodate non-ambulatory clients in a wheel chair. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in client's own closet. The smoke detectors and carbon monoxide detectors are inter connected and they are all operational. Stove burners, oven, microwave, washer, and dryer are all working probably. The facility is equipped with central air and heat. All the cleaning supplies and chemicals are locked in the storage room next to the living room. The hot water temperature in 3 bathrooms were tested between 116.9 degrees F and 118.4 degrees F which is within the Title 22 Regulation. There's no pool/jacuzzi or pets in the facility. The facility has a land line telephone system on the premises.