Facility Evaluation Report

Licenisng Program Analysts (LPA)s Mary Flores and Daniel Konishi conducted an announced pre-licensing visit at the facility. LPAs met with Guadalupe Trevizo, Ernesto Vasquez- applicants, Yadira Jasso and Nicole Snyder Easter Seals representatives were present.

The facility has an approved fire clearance for six (6) non-ambulatory clients between the age of 18 -59 years old, of which all may be bedridden. The facility consist of six (6) client bedrooms, three (3) bathrooms, a living room, a kitchen, a dining room, a laundry room, and a garden area.

LPAs toured the facility with Guadalupe Trevizo and Ernesto Vasquez and observed the following:

Facility is in good repair indoor and outdoor. Living room is fully furnished. Kitchen area is clean, in good repair, dishes and utensils were observed. Food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Refrigerator's temperature was observed at 35 degrees F., and freezer's temperature was observed at 0 degrees F. Closet's in the hallway across the laundry room will be use to stored sharps, medication, cleaning supplies and client files. Dining room was observed furnished.

Laundry area was observed with locking cabinets for items that will be inaccessible to clients. Licensing posters, Let us Know (PUB 745), clients' personal rights were observed in a board in the laundry room.

A total of 6 client bedrooms were observed, each has the required furniture; a bed, a chair, a chest drawer, a night stand, and bedding supplies. Additional bedding supplies and grooming supplies were observed in each of the client's closets. Bedrooms #1-#4 have an exit door.

Bathrooms were observed, 2 out of the 3 bathrooms are full bathrooms. Each is in working condition, showers were observed with grab bars and skid mats. Water temperature was tested between 107.7 and 108.3 degrees F., which is within the required temperature of 105-120 degrees F.

Two storage sheds are located in the back of the house. Garden area is clean and a shaded seating area is located outside the dining area. (CONTINUED ON LIC 809C)