Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon conducted an announced pre-licensed visit and met with Applicant Matthew DeVera and Oliver Elma for the purpose of conducting a Pre-Licensing Inspection / Component III visit. The facility has an approved fire clearance to be licensed to serve four (4) ambulatory Adults clients Ages 18-59. Property has a back ADU, address 1706 Lincoln Ave approved and only to be used by staff, will remain locked and inaccessible to clients. The facility is a single story home: 4 bedrooms, 3 bathrooms, dining/ livng room , backyard and ADU home located in Pasadena,CA.

The physical plant was toured inside and out alongside with DeVera and Elma. Pre-Licensed Inspection Tool was used.

Each bedroom is designated as a private bedroom. Bedrooms are equipped with one bed, night-stand, chair, sufficient lighting, appropriate closet and drawer space.

All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Mattresses and bedsprings are in good repair.

Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture.

Sufficient supply of linens available to permit weekly changing and are stored in storage cabinet.

Sufficient personal hygiene supply available.

All (3) bathrooms have a working toilet, wash basin, and showers. All showers have a grab bars and non-skid mats.

There are enough bath towels, hand towels and wash cloths for all clients.