Facility Evaluation Report

On 4/29/2025, at approximately 1:00 PM, Licensing Program Analyst (LPA) Angelica Segovia conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Allan Baldemor.

An application was submitted to Community Care Licensing Division-CCLD on 01/23/2025, Initial license for an Adult Residential Facilities (ARF). The requested capacity is for four (clients) of which two (2) can be ambulatory and two (2) non-ambulatory. The fire clearance was approved on 02/12/2025.

Structure: The facility is a single-story building with seven (7) bedrooms and two (2) bathrooms which include two (2) designated staff rooms and one (1) designated staff office.

Entrance: Upon entrance, required postings such as: Personal Rights Adult Residential Facilities, Rights of Resident by Council, Facility Sketch, and See Something Say Something were observed.

Common Areas: The living room and dining room were observed to be neat, clean, and organized with sufficient seating for both clients and staff. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature of seventy (70) degrees. No firearms were observed or will be maintained on the premises. LPA observed a working telephone located in the kitchen. LPA observed a fireplace to be covered and inaccessible to clients.

Client/staff files: The client and staff files will be kept in the staff office located aside the kitchen. Files will be kept in a locked cabinet inaccessible to clients. LPA observed a complete First-aid kit not limited to tweezers, bandages, digital thermometer, and scissors.