Facility Evaluation Report

At approximately 10:00 am Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing visit with administrator. Identification of the Applicant/administrator was verified by CA Driver’s License.

The facility has a capacity of four (4). Application received for four (4) Ambulatory residents.

Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6.

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

The common areas (kitchen, living room, and dining areas) were appropriately furnished, and lighting was adequate. The facility contained a seven-day supply of non-perishable food and a two-day supply of perishable foods.

LPA observed the living room and dining room are combined. The living room area contained a large sectional sofa with sufficient seating for residents, a coffee table, and television. The dining room contained a dining room table and four (4) chairs.

There are 4 (four) bedrooms. Bedroom # 1 has bed, linens, television,nightstand, lamp, chest of drawers, a chair and a closet available. All other rooms are not completely furnished and furniture observed to be damaged in one or more rooms.

The linen is stored at end of hallway in cabinets that was fully stocked with clean linen.

There are two (2) bathrooms which contained hand soap, paper towels, trash can, and slip resistant mats. The water temperature was recorded at 2:05 pm and was at: 111.7- and 112.0-degrees F.