Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an announced pre-licensing visit. LPA met with Oghenetega Ugbeyide (Applicant) and Brittany Jones (Back-Up Administrator). The facility is to serve 4 non-ambulatory individuals. Applicant will be contacting San Gabriel Pomona Regional Center and inquire about vendorization. Component III was also completed during this visit.

This is a single-story home that consists of: (4) bedroom (each client will have their own bedroom), (2) bathrooms (1) of which is located inside room #4, living room, dining area, family room, kitchen, laundry room and attached garage.

Building and grounds are free from hazards.

Carbon monoxide detector was tested and operable. Located in the hallway leading to the bedrooms.

Fire extinguisher (service date: 11/07/23) located in the kitchen and attached garage appeared to be full.

Cleaning solutions (under kitchen sink) and sharps are locked in the kitchen.

Pantry's cupboards, freezers, stoves, microwaves, refrigerator and counters are clean.

Two-day supply of perishables available, seven-day supply of non-perishable available. Water supply observed.

The facility has dining table and sufficient chairs.

There is a designated space inside a kitchen cabinet for Medications to be locked.

First Aid Kit inspected. American Red Cross First Aid Manual observed.

**Refer to LIC 809C for the continuation of this report**