Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted a pre-licensing visit. LPA met with applicant Mikol Greene. An initial application was submitted to Community Care Licensing Department (CCLD) for an Adult Residential Facility to serve 4 ambulatory clients in the age range of 18 through 59. The fire clearance has been approved for four (4) Ambulatory Clients. This property has never been licensed. The physical plant was toured with the applicant. Component III was conducted with applicant.

The facility is in a residential area and is a one-story family home. There are two (2) client bedrooms both bedrooms are shared, one (1) bathroom, living room, dining room, kitchen office/laundry room, front yard, and back yard. LPA conducted the tour with Mikol Greene and observed the following: Smoke detectors were observed in common areas and in each client’s bedroom. There are 2 carbon monoxide detectors in hallway and living room. Client’s bedrooms were observed to have required furniture such as bed frames, dressers, chairs, lamps, and sufficient closet space. The required bedding was also observed. The home has one (1) bathroom and was clean and sanitary. The water temperate was tested and measured at 119.2 degrees, which is within the required 105-120 degrees. There is a fire extinguisher in living room. All appliances in kitchen were observed to be clean and operational. The sharp knives are located in the kitchen drawer that is inaccessible to clients. Cleaning supplies and chemicals are stored in a locked cabinet in kitchen cabinet. Medications are locked in a cabinet in kitchen. Laundry/office was clean and clear of obstruction. The garage is detached from home and used for storage. The backyard has a shaded area with patio furniture. There is a garden area for clients. The home does not have a pool or any large bodies of water. The home has all required posters. There are no cameras inside the home. No records were reviewed since the home has never been licensed. Per California Code of Regulations, Title 22, the facility meets the physical plant requirements.

Exit interview held and a copy of the report was provided to applicant.