Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an announced pre-licensed visit and met with Administrator Tiffany Vander Poorten for the purpose of conducting a Pre-Licensing Inspection / Component III visit. This Pre-Licensing Inspection is due to change of location. This is the initial visit.

The facility has an approved fire clearance to be licensed to serve five (6) non ambulatory clients. The facility is a single-story home: 4 bedrooms, 2 bathrooms, dining/ living room, family room, backyard with locked storage shed, and attached garage located in Glendora, CA.

The physical plant was toured inside and out alongside Tiffany Vander Poorten. 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 in the living room.

· 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.

· There is an emergency exiting plan with emergency phone numbers posted.