Facility Evaluation Report

Licensing Program Analysts (LPA) Ana Soto conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation.

An application was submitted to Community Care Licensing Department (CCLD) on 12/06/2022 for an initial license for Residential Care For Elderly 60 years and above. The requested capacity is for (6) residents, (2) ambulatory and (4) non-ambulatory. Structure: Facility is a (7) bedroom, one (2) full bathroom, single story house with small front porch with small ramp, stairs on east side of facility, back covered porch with ramp, and attached 2 car garage. The facility is a orange stucco with wood structure and small backyard. Front yard landscape is in good condition. Rear patio is covered. and has table and chairs, washer/dryer area with wash basin. Signal System : Signal system in facility. Bedroom Residents: There shall be no more than two residents per bedrooms. 6 Bedrooms are designated private bedrooms properly equipped with regulation guidelines of one bed, one chair, one night stand, one lamps and overhead lighting. Bedroom Staff: One bedroom will be used for awake staff. Bathrooms: 1 full bathroom located in the east side of facility next to the kitchen and 2nd bathroom is located next to living room between bedroom #3 and bedroom #4, both have working toilets and wash basins. Bathrooms also contain grab bars, folding bench, and non-skid mats. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen is stored in hallway closets, and bathroom cabinet. Emergency Phone Numbers, Exit Plan, & Menu: Emergency numbers and menu are posted and readily available for review in the north hallway. Facility has a land line telephone located in the office. 2 Fire extinguishers, one 4A60BC mounted in laundry area, and the second 4A60BC is next to the back door which is labeled, they are tagged with current annual checks.