Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with Administrator Salvacion Butler. A Change in Ownership (CHOW) Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on July 19, 2024. A fire clearance was approved on January 3, 2025, for five (5) non-ambulatory residents and one (1)bedridden resident, for a total capacity of six. The bedridden fire clearance is for room #1. A dementia plan of operation has been submitted. A hospice waiver has been requested for six (6) residents pending the Manager's approval. The smoke alarms and carbon monoxide detector are battery-operated and functional. The facility has multiple fire extinguishers with a service date of 09/05/2024. The fire extinguishers are located in the dining room, kitchen, second hallway area, and by the garage.

A tour of the physical plant was initiated at approximately 10:10 am and the following was observed:

KITCHEN : The facility has a Kitchen area equipped with a refrigerator, microwave oven, and sink. Adequate supplies of perishable and nonperishable food and dining ware accommodated a maximum capacity of six (6).

BEDROOMS : There are five (5) bedrooms designated for residents' use. Bedrooms #2, #3,#4, and #5 are private rooms for non-ambulatory residents. Bedroom#1 is a shared room bedroom with one (1) bedridden resident as per the fire clearance approval. The applicant furnished the resident bedrooms with beds, nightstands, chairs, dressers, bedding, and linen. The bedrooms have sufficient lighting and closet space.