Facility Evaluation Report

Licensing Program Analysts (LPAs) Gary Tan and Angelica Segovia conducted an announced Pre licensing visit at this facility on this date. LPAs met with Licensee representative Cheryl Balquiedra and informed the purpose of the visit. A Fire Clearance dated 08/23/24 is approved for four (4) non-ambulatory clients. This will be a North Los Angeles Regional Center (NLARC) vendored facility Level III.

LPAs toured the facility inside and out at 10:30 AM. Dual smoke and carbon monoxide alarms are hard wired and interconnected, tested and observed to be operational. The facility has four (4) client bedrooms and four (4) bathrooms. Each room is furnished with beds, lights, night stands and chair. One additional (1) bedroom and bathroom is designated for staff use. Sufficient closet space was observed for each room. Medication will be stored in a cabinet in the living room. Medication storage is equipped with a lock to ensure medications will not be accessible to clients. Storage for client and staff records are also observed to be locked in the same cabinet. There is a working telephone and internet services on the premises.

Common areas were appropriately furnished and lighting was adequate. LPAs observed a fully charged fire extinguisher in the dining room which was last inspected on 08/06/24. A complete first aid kit was observed to be kept inside the medication cabinet. The water temperature in client restrooms was measured at a range of 116.7°F to 118.9°F. Appliances in the kitchen were clean and all appeared functional. The laundry room has new washer and dryer which are properly installed. Laundry detergent and other cleaning supplies are stored in a locked cabinet inside the laundry room located along the bedroom hallway. There is no body of water in the facility. (continued to LIC 809-C)