Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza made an Announced visit and met with Licensee Jeaneth Cabrera to conduct a Pre-Licensing evaluation.

An application was submitted to Community Care Licensing Department (CCLD) for an initial application of an Adult Residential Facility (ARF) to serve developmentally disabled adults ages 18-59. The home will be vendorized by Eastern Los Angeles Regional Center as a level 4i Adult Residential Facility (ARF). The total requested capacity is for two (2) ambulatory residents.

Structure: The facility is a single story home located in a residential neighborhood. It consists of three (3) bedrooms [2 resident bedroom & 1 live-in staff], living room, dining room, laundry room, kitchen, detached garage, and backyard with covered patio area. Bedrooms : All bedrooms are private and meet HCBS federal requirement #7 "privacy in his/her sleeping or living unit. Room doors had locks. Bedrooms are equipped with one bed, night-stand, chair, lamp, and overhead lightning. Bathrooms: Have a working toilet, wash basin, and bathtub. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens are stored in facility closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. One (1) fully charged fire extinguishers is in the home. Facility has an operable land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Smoke Detectors : There are electrical & inter-connected dual smoke/carbon monoxide detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator , oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff.