Facility Evaluation Report

At 10:30am, Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an announced Pre-Licensing visit to this facility and met with the Administrator. This is an initial application. The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6.

Today’s site visit consisted of LPA touring the physical plant inside and outside and observed the following:

Facility Fire clearance was conducted on 11/21/23 and approved for six (6) Ambulatory residents only. The facility has dual carbon monoxide and smoke alarm system. There is a fire extinguisher located in the kitchen with a date of purchase of 03/21/2024. There will be a functioning telephone on the premises. An emergency exit plan/sketch is posted in each bedroom and in the hallway wall with other posting requirements. There are three (3) bedrooms designated for resident use. Bedrooms were observed to be appropriately furnished. There are one in a half (1.5) bathrooms in the facility. Bathrooms have non-skid mats and appropriate grab bars. Trash cans were observed to have closed tight fitting lids.

The common areas (living room, kitchen, and dining areas) were appropriately furnished, and lighting was adequate. The living room has a television and comfortable furniture. Residents, staff records and medication will be stored in a locked cabinet by the administrator's desk. There is one (1) first aid kit and is readily available.

The kitchen knives will be stored in a locked drawer in the kitchen. The kitchen cleaning supplies will be stored in a locked cabinet as well. Laundry detergents, cleaning supplies and other toxins will be stored in locked kitchen cabinet. LPA observed the garage to be locked and inaccessible to residents in care. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional.