Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an announced visit with applicant VENKATESWARA VANKINA. The purpose of the visit was to conduct the Pre-Licensing visit.

An application was submitted to CCLD on 1/24/2023, for a Initial License of an Adult Residential Facility . The requested capacity of 6 residents, (4) ambulatory, (0) non-ambulatory and (0) may be bedridden.

The facility is part of a single story home located in a residential area and contains the following: living room, dining area, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage cabinet for medications and sharps, (4) client rooms, (2) bathrooms for client use; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for client use. A detached garage inaccessible to residents for storage. Washer and dryer on property. The residence is equipped with central air and heating. Facility has a covered fireplace inaccessible to clients.

Accommodations : Adequate accommodations observed throughout facility. Lighting: Sufficient Lighting throughout. Hallway and Doorways: Free and clean of obstruction and debris. Client Rooms: Bedrooms #1-#4 are for one (1) client each. Bedroom #2 and #3 have a shared bathroom. All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: Bathroom #1 and #2 have a working toilet, wash basin, shower and nonskid mats.

Linens & Hygiene Supplies: Required linen/supplies which include, pillowcase, fitted sheet, blankets, bedspreads. Mattress pads were observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There is (1) cordless phone for residents use. Fire Extinguisher fully charged and up to date