Facility Evaluation Report

On 08/02/2023, Licensing Program Analyst (LPA) Lizeth Villegas conducted an announced visit to this home. LPA was greeted by Tiki Thompson and Verretta Boatner and explained the purpose of today’s pre-licensing (CHOW) inspection visit.

An application was submitted to CCLD on 06/08/2023 for CHOW of an Adult Residential Facility The applicant requested a capacity of three (3) ambulatory of which one (1) may be non-ambulatory adults ages 18-59. Residents are linked to Harbor regional center.

The facility is a one-story house located in a residential neighborhood and consists of four (4) bedrooms, two (2) bathrooms, one (1) bathroom is for staff only, two (2) car garage, living room, family room, staff work area, dining area,laundry room and kitchen. The facility is clean, sanitary, and in good repair. Protective devices are in place to include non-slip material on rugs. All window screens are clean and in good repair.

The facility has three (3) bedrooms ambulatory clients and one (1) bedroom for a non-ambulatory resident. All rooms include required furniture. No client bedroom is a passageway to another room, bath, or toilet.

Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the closet adjacent to the client’s bedrooms and bathroom.

Emergency Phone Numbers, Exit Plan & Menu:

Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There are (2) fire extinguisher located in the family room and in the kitchen area.