Facility Evaluation Report

Licensing Program Analyst (LPA) Wong, conducted an announced visit to the facility for purpose of a Pre-licensing evaluation and met with the administrator Kevin Van Beek.

An application was submitted to CCLD on 01/18/2023, for change of ownership for an Adult Residential Facility to serve Developmentally Disabled Adults for ages range 18 through 59. The requested capacity is for two (2) ambulatory and two (2) non-ambulatory.

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 located in a residential neighborhood area. The facility includes dining area, living room, kitchen, laundry area, three clients bedrooms, two clients bathrooms and a detached garage. The passageway, walkway and a patio is free from obstruction. For clients bedrooms, there shall be no more than two clients per bedroom. Bedroom#1 and #2 has one bed, one chair, one drawer, night stand, and sufficient lighting and closet space. Bedroom#3 has two beds, two drawers, two night stands, chair, and sufficient lighting and closet space. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hallway cabinet and the extra personal hygiene products are stored under the sink of Bathroom#2. All the bathrooms have a working toilet, bath/tub and shower. Bathroom#2 is accommodate for non-ambulatory client. The hot water temperature in both bathrooms were tested between 114 and 116.7 degrees F. which is within Tittle 22 regulation. All the post are posted and reviewed on the wall near the laundry area. The facility also has a land line telephone system. The smoke detectors are interconnected and located in each bedroom and common area and they are working probably. The carbon monoxide detectors are located near the staff desk in the living room and working well. All the appliances in the kitchen and living room are working probably. All the chemicals and cleaning supplies are stored under the sink and garage and they are all inaccessible to clients.