Facility Evaluation Report

At 9:30 AM Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an announced pre-licensing visit to the above facility and met with administrator .

Fire Clearance was approved on 10.9.2024 for a maximum capacity of five (5) non-ambulatory residents and one (1) bedridden.

The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of team touring the physical plant inside and outside and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 9:36 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

FIRE EXTINGUISHER was last purchased on 10/1/2024 is located in the kitchen. First-aid is complete and new.

BEDROOMS: There are five (5) bedrooms designated for client use. All bedrooms are furnished with beds, dresser and required bedding and linen. Extra linen is available in the hallway cabinet. The bedrooms have sufficient closet space and have sufficient lighting. Facility will have awake staff. Bedroom #1 is shared and is located by the kitchen and living room. Bedroom #2, bedroom #3, bedroom #4, and bedroom #5 are private bedroom located by the hallway.