Facility Evaluation Report

On 08/13/2024 at 10:00 am, Licensing Program Analyst (LPA) Lorena Casillas conducted an announced Pre-Licensing Inspection with Licensee Edward Jackson. An application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on 07/25/2024. This facility is a five (5) bedroom house with two (2) bathrooms. A fire clearance was approved on 07/19/2024, for four (4) ambulatory clients for a total capacity of four (4). Bedrooms 1-4 are designated for ambulatory clients, the 5 th bedroom is to be used as an office. 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.

The Component III presentation was conducted from 10:00 am until 12:00 pm with Licensee.

A tour of the physical plant was initiated at approximately 12:10 pm and the following was observed:

COMMON AREAS: These included the living room and dining room areas, which were equipped with living room furniture, a television, tables, and chairs. The dining room table is large enough to accommodate up to four (4) clients. There were no visible immediate hazards. The smoke alarms are hard wired, inter-connected, were tested and are functional. The carbon monoxide detector is functional.

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave, oven and sink. There was an adequate supply of nonperishable food and dining ware to accommodate a maximum capacity of four (4). Knives will be locked in a kitchen cabinet and are within a locked box. There is a fire extinguisher located in the kitchen and last purchased on 05/24/24. Medication will be stored in a locked cabinet in the kitchen. The first aid kit is located in a locked kitchen cabinet.