Facility Evaluation Report

At 9:35 am Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing

visit with administrator. Identification of the Applicant/administrator was verified by CA driver’s

The facility has a capacity of five (5). Application received four (4) non-ambulatory and 1-bedridden client.

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. The facility is a

Today's site visit consisted of LPA touring the physical plant inside and outside and observed the

following: The common areas (kitchen, living room, and dining areas) were appropriately furnished, and

lighting was adequate. The living room has a television and comfortable furniture.

The facility has a variety of adequate perishable and non-perishable food supply. Appliances in the

kitchen appeared to be functional. The sharps are stored and locked in drawer in kitchen.

Laundry room located in garage. Washer and dryer observed to be in good repair. Toxins stored in locked garage.

There is one (1) fire extinguisher: located in kitchen area attached to wall near patio door. Fire extinguisher

observed to be fully charged. Dual Smoke and Carbon Monoxide detectors were observed all over

the facility, tested, and observed to be operational at approximately 11:20 am.

There is a functioning telephone/landline on the premises. An emergency exit plan/sketch is posted

There are three (3) bathrooms in the facility: The hot water was tested for the bathrooms and

measured at 118.6,118.6 and 117.1 °F. The bathrooms have non-skid mats, trash cans with lids