Facility Evaluation Report

Licensing Program Analysts (LPA) Jey Cardenas made an announced visit and met with applicant Beverly Chiong to conduct a Pre-Licensing evaluation. An application was received by Community Care Licensing Department (CCLD) on 10/22/21- change of ownership to serve Adults ages 18-59 years; requested capacity is for four (4) ambulatory clients, zero (0) non-ambulatory, and zero (0) bedridden. LPA Cardenas conducted covid-19 risk assessment, based on the assessment the facility is clear of covid-19 infection. This location is currently going through a change of ownership and is currently licensed as SeaBreeze Homes #198600606, there are currently two (2) clients in care.

Structure: Facility is a one story family home located in a residential area, the facility includes: four (4) client bedrooms, two (2) full bathrooms, living room, dining room, kitchen, office nook, attached car garage/ laundry area, outdoor/indoor activity area, shaded patio area, front yard landscape is in good condition at time of visit.

Bedroom Residents: Bedrooms are equipped with one bed per client, night-stand, chair, and overhead lightning. Bathrooms: Two (2) bathrooms have a working toilet, wash basin, and a bathtub. There will be zero (0) live in staff. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, fitted sheet, blanket and bedspreads. Three two fully charged fire extinguishers located in the dinning room, and down the hall near bedroom#4. LPA observed two plastic containers with sufficient hygiene supplies for clients. LPA observed activities available for clients. Staff files/ client files and medication will be stored in locked tall cabinet which will be located in the office space, first aid kit, and first aid manual available at time of visit. Facility has sanitation station located front entrance.

Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in kitchen cabinet inaccessible and under lock. Smoke Detectors/Carbon Monoxide(s): Facility is equipped with operational dual and hardwired smoke detectors/ carbon monoxide in all bedrooms and mounted on the ceiling in the hallway. LPA observed