Facility Evaluation Report

Licensing Program Analyst (LPA), Christine Wong, conducted an announced visit to the facility for purpose of a prelicensing evaluation and LPA met with Administrator Kevin Van Beek and assisted with the visit.

An application was submitted to CCLD on 01/18/2023, for Change of Ownership for a Adult Residential Facility] to serve Developmentally Disabled Adults for age range 18 through 59. The requested capacity is for six (6) where three (3) can be non-ambulatory in Room#3 and #4.

During today's visit, LPA Wong utilized the Compliance and Regulatory Enforcement (CARE) tools for the pre-licensing visit today :

1. Physical Plant and Environmental Safety: The facility is a single story house and its located in a residential neighborhood area. The facility includes: living room, dining area, kitchen, four (4) clients bedrooms and three(3) bathrooms, staff office and attached garage. The client bedrooms are spacious and will easily accommodate the client's furnishings. The passageway, walkways, driveways and patio are free from obstructions. There shall be no more than two clients per bedroom. Bedroom#1 and #4 has two beds, two chairs, two night stands, drawers, required beddings and sufficient lighting and closet space. Bedroom#2 and #3 has one bed, one chair, one night stand, drawer and required bedding and sufficient lighting and closet space. All three (3) clients bathrooms are clean and sanitary and has a working toilet and bath-tub/shower. There is one bathroom (Bathroom#3) that will accommodate non-ambulatory clients in a wheel chair. Each client's bed have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hallway cabinet and garage. The facility also has a ample supply of personal hygiene products and stored in the cabinet in the garage. The smoke detectors and carbon monoxide detectors are located in each client's bedroom and common area and they are all working probably. The stove burners, oven, microwave, washer and dryer are working probably. All the cleaning supplies are stored and locked under the sink and in the garage and inaccessible to clients.