Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative/administrator, Araceli Andrade and staff, Violeta Tagactac. A Change in Ownership (CHOW) Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on February 23, 2024. A fire clearance was approved on August 14, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The applicant is also requesting a hospice waiver to retain two (2) residents. The smoke alarms and carbon monoxide detector are dual and inter-connected. There are two additional carbon monoxide detectors installed in the living room and in the hallway. The facility has one fire extinguisher stationed in the kitchen. The charge date is 05/10/24.

A tour of the physical plant was initiated at approximately 10am, after the Component III power point presentation was held. The following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, toaster oven, stove/oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives are kept locked in a kitchen drawer.

BEDROOMS: There are a total of seven (7) bedrooms in the facility. Six (6) bedrooms are designated for resident use. One (1) bedroom designated for staff. All six bedrooms are private. The bedridden fire clearance is approved for one (1) resident at any time for either room #5 or #6 (per STD 850). The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space.