Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an announced Pre-licensing Visit to verify that the home meets Title 22 requirements. The Pre-licensing visit using the CARE tool was conducted with Zohrab Zargery, Applicant.

The home is a single storey family home consisting of a living room, a dining room, a kitchen, 4 bedrooms, 2 full bathrooms and a attached garage. The home is fire cleared for 1 AMBULATORY and 3 NON-AMBULATORY clients. Bedrooms #2, #3 and #4 are approved for Non-ambulatory clients.

The following was observed on today's visit:

the living room has a long sofa and a coffee table

the dining room has a long table with 6 chairs

the kitchen has a working stove and refrigerator. Located in the kitchen are 2 locked filing cabinets that will be used to store medications and facility files. Knives will be stored in a locked drawer

the laundry room has a washer and dryer. Cabinets in the laundry room will be used to store detergents and cleaning supplies

the back bathroom adjacent to the laundry room is designated for staff use

the 4 resident bedrooms all contain a queen size bed, a chair, dresser, lamp, closet and a night stand.

The beds were observed with a mattress cover, fitted sheet, flat sheet and comforter

a bath towel and a hand towel were observed in the hamper

all the facility windows have window blinds. No window bars were observed.

First aid kit , scissors and first aid manual was observed

The only fire extinguisher was observed in the kitchen