Facility Evaluation Report

On 2/10/2023, Licensing Program Analyst (LPA) Melissa Spaeth conducted an announced Pre-Licensing visit to this facility and met with applicants Jamelena Joy S. Enola & Jean Sevilla. This is an initial application for an adult residential care facility. A fire Clearance dated 12/29/2022 was received for six (6) residents, of which four (4) could be non-ambulatory residents, and two could be ambulatory. The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6.

The Component III presentation was conducted from 9:10 am until 10:00 am with applicants.

Today’s site visit consisted of LPA touring the physical plant inside and outside with the applicants from 10:00 am until 10:55 am. LPA observed the following:

Facility has a fire extinguisher, with a date of purchase of 10/03/2022. There is a functioning telephone on the premises. The facility phone number 661-526-5959. Emergency exit plan/sketch is posted on the living room wall with other posting requirements. The smoke/carbon monoxide detectors were checked at 10;55 am and were functional.

There are (4) resident bedrooms (two single bed rooms and two double bed rooms). LPA observed bed linens, chest of drawers, closet, night stand, and lamp in each bedroom. The bedrooms were neat and clean.

The common areas (living room, kitchen and dining areas) were appropriately furnished, and lighting was adequate. The living room was furnished with games, comfortable seating and a television.

Resident and staff records are stored in a locked hallway cabinet. LPA observed a linen closet which contains towels, bed linens, and blankets.