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 licensee, Marilen Basa.

Fire Clearance was approved on 3.10.2025 for a maximum capacity of four (4) non-ambulatory residents.

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 touring the physical plant inside and outside and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 9:10 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of four (4) clients. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

FIRE EXTINGUISHER was last purchased on 1.6.2025 is located in the kitchen. First-aid is complete and new.

BEDROOMS: There are six (6) bedrooms in the facility, four (4) bedrooms are designated for client use. All bedrooms are furnished with beds, dresser, required bedding and linen. Extra linen is available in the closet of the bedroom. The bedrooms have sufficient closet space and have sufficient lighting. Facility will have overnight staff. Bedroom #1, bedroom #2, bedroom #3, and bedroom #4 are private and is located by the hallway of the facility. Bedroom #5 and bedroom #6 are designated for staff use where the office is located as well.