Facility Evaluation Report

Licensing Program Analysts (LPA's) Jose Villalobos, Tena Herrera and Erik Zaragoza conducted an announced visit with Applicants Diana Gonzalez and Jesse Quezada. The purpose of the visit was to conduct the Pre-Licensing visit.

An application was submitted to CCLD on 11/15/2022, for an Initial License of a Adult Residential Facility for ages 18-59 . The requested capacity of 4 clients, (4) ambulatory, (0) non-ambulatory and (0) may be bedridden.

The facility is part of a single story home located in a residential area and contains the following: living room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage space for medications and sharps, (4) client rooms, (3) bathrooms for clients; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for client use, area for washer and dryer. The residence is equipped with central air and heating.

Accommodations : Adequate accommodations observed throughout facility. Lighting: Sufficient Lighting throughout. Hallway and Doorways: Free and clean of obstruction and debris. Resident Rooms: Bedrooms #1-#4 are for (1) ambulatory client each.. All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: Bathroom #3 is attached to bedroom #3. All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Linens & Hygiene Supplies: Required linen/supplies which include, pillowcase, fitted sheet, blankets, bedspreads. Mattress pads were observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has (1) cordless phone for residents use. Fire Extinguisher 1 and 2 fully charged and up to date..