Facility Evaluation Report

Licensing Program Analyst (LPA) Tihesha Smith arrived at the facility on 12/28/2023 at 8:00am to conduct an announced Change of Location visit. LPA Smith was greeted by the administrator Sandra Bello and disclosed purpose of the visit. Administrator identity was verified by valid California Driver’s License.

Fire Clearance is approved for 5 non-ambulatory and 1 bedridden resident. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. First-aid kit is complete; facility has adequate linen, nonperishable food supplies. There is one (1) fire extinguisher in the property located near front door. There is no swimming pool or other body of water. Facility has working alarms on all exits. Front and backyard are fenced.

The kitchen, living and dining room combination area observed to have some furnishings, sufficient lighting and observed to be clean. The kitchen glass table and the living room coffee table to be moved by current tenant by 12/30/2023 per administrator. The laundry room is next to the kitchen: appliances observed to be in good repair. The garage used for storage and is part of the facility however the property owner has items stored in the garage. Administrator revealed owner will have items moved by 12/30/2023.

There are four (4) bedrooms and two (2) bathrooms in the home: with one of the bathrooms in Room #4. The two (2) bathrooms observed to be clean with grab bars, mats, and trash cans with lids. Three (3) of the four (4) rooms were unoccupied and have beds delivered by hospice. Bedroom # 2 has owners personal items stacked by closet door and Room #4 is currently occupied with two (2) tenants. Administrator revealed tenants will be completely out of facility on 12/30/2023. LPA observed tenants in the process of moving items out.