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 1:20 p.m., and met with applicant Suzie Hastings. This is a Change of Ownership (CHOW) application for an Adult Residential Facility for four (4) ambulatory residents.

At 1:30 p.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there

are no health and safety hazards, and 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 next to the dining room area. Hot water temperature was recorded at 112.2 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 resident use, each room has double occupancy. Lighting in the

rooms appeared adequate. All bedrooms had adequate closet and drawer space for clothing and personal