Facility Evaluation Report

On 07/29/2022, the pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived at the facility at 10:00 a.m., and met with applicant Suzie Hastings. This is a Change of Ownership (CHOW) application for an Adult Residential Facility for three (3) ambulatory residents, and one (1) non-ambulatory resident.

At 10:30 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there

are no health and safety hazards, and that facility is in compliance with Title 22 Regulations.

KITCHEN: A seven day supply of non-perishable food was available. The supply of dishes is adequate.

Appliances in the kitchen were clean and all appeared functional. Kitchen, and house cleaning supplies are

stored in locked cabinet in the garage area. Hot water temperature was recorded at 114.2 degrees

Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides, or toxins stored near food, or

BEDROOMS: There are three bedrooms for residents use, one room has double occupancy and two bedrooms have single occupancy. Lighting in the rooms appeared adequate. All bedrooms had adequate closet and drawer space for clothing and personal belongings.

BATHROOMS: The bathrooms are fully stocked with paper towels and hand soap. The shower has non-skid

surface/mat. Hot water temperature was recorded at 112.6 degrees Fahrenheit. Hand washing signs were visibly posted in each bathroom.