Facility Evaluation Report

Licensing Program Analysts (LPA) Ana Soto conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation.

An application was submitted to Community Care Licensing Department (CCLD) on 10/10/2022 for a change of ownership license for an Adult Residential Facility to serve Developmentally Disabled Adults for ages 18-59 years. The requested capacity is for (4) clients ambulatory, (0) non-ambulatory, and (0) bedridden. Structure: Facility is a three (4) bedroom, one (2) full bathroom, single story house with small covered front porch, covered back patio, and small side porch off the kitchen, an attached 2 car garage. The facility is a brown wood/ stucco structure with large front yard and small wide backyard. Front yard landscape is in good condition. Covered back patio has 2 tables, chairs. Signal System : No signal system in facility. Bedroom Residents: There shall be no more than two clients per bedrooms. bedrooms are designated client bedrooms properly equipped with regulation guidelines of two beds, two chairs, two night-stands, two lamps and overhead lighting. Presently, 4 bedrooms are occupied by 4 clients. Bedroom Staff: No bedrooms will be used for awake staff. Bathrooms: 1st - full bathroom located in Bedroom #2. 2nd bathroom is located between bedroom #2 and Bedroom #3 both bathrooms have a working toilet and wash basin. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen is stored in hallway closets. Emergency Phone Numbers, Exit Plan, & Menu: Emergency numbers and menu are posted and readily available for review in kitchen bulletin board. Facility has a land line telephone located in the kitchen area and living room. 1 Fire extinguisher, one 1A10BC mounted in kitchen wall next to the exit door, which is labeled, it is tagged with current annual checks.