Facility Evaluation Report

At 9:00 AM Licensing Program Analysts (LPA), Leslie Ngo-Castaneda arrived at the facility to conduct an announced pre-licensing visit to the above facility LPA met with administrator at 9:30 AM.

Fire Clearance was approved on 1.27.2025 for a maximum capacity of six (6) non-ambulatory residents; one (1) bedridden; hospice waiver for six (6).

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 9:38 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 cabinet and inaccessible to residents.

FIRE EXTINGUISHER was last purchased on 12/18/2024 is located in the kitchen. First-aid is complete and new.

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