Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced Pre licensing visit to this facility on this date. LPA met with Administrator Gibson Amize and explained the purpose of the visit. This is a change of ownership from single proprietorship to a corporation. The applicant is "Godson Home, Inc." Fire clearance dated 12/20/23 was received for four (4) non-ambulatory residents only. This is a North Los Angeles Regional Center (NLARC) vendored facility Level II.

Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6.

Facility is a single storey home. Today's site visit consisted of LPA touring the physical plant at 9:15 AM inside and outside and observed the following:

Facility has four (4) client bedrooms; all private rooms. One (1) additional bedroom for staff use; facility has

two (2) bathrooms. There is no body of water in the facility.

Bedrooms were toured and observed to be clean and appropriately furnished. There are sufficient supplies of linen and towels in the linen cabinet.

Physical plant was checked for cleanliness and condition. Facility was observed to be in good repair and clean during today's visit. There is a working telephone and internet at the facility.

Bathrooms were observed to be clean and with necessary supplies. Hot water temperature measured at a range of 111.3°F to 117.6°F.

Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition. (continued on LIC 809-C)