Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted a case management visit regarding capacity increase request submitted to the Department on 6/3/25. LPA met with Silvina Gomez and explained the reason for the visit.

The home is currently licensed to serve (14) Ambulatory clients between the ages of 18-59. The facility is located in a residential area and consist of a two level home with a living room/dining room area, a kitchen, a backyard, (8) bedrooms, (3) bathrooms, a front porch, a detached garage, and a shed out back.

No changes have been made to the structure of the home. The capacity increase will take place by changing an office space into a single client bedroom. The Fire Clearance was granted on 6/3/25 for (15) Ambulatory clients between the ages of 18-59.

During today's visit LPA reviewed the facility to see if the changes noted during the visit conducted on 6/27/25 were done:

Administrator remove office equipment and furnish client bedroom #3 with a bed, dresser/night stand, portable closet, a desk, and a chair. The room has sufficient lighting.

Administrator remove the door in bedroom #8 removing passageway between the room.

The physical plant meets Title 22 Regulations.

The following needs to be complete and submitted to the department prior approving capacity increase:

Administrator needs to submit to the department a copy of facility's sketch in which the correction of bedroom #8 and bedroom #9 has been made to show them as one bedroom including accessibility between the shared space.

Exit interview was conducted with Silvina Gomez and a copy of this report was provided.