Facility Evaluation Report

Licensing Program Analyst (LPA) Angelica Rea conducted an announced visit to the facility for the purpose of a Pre-Licensing Inspection. LPA met with Licensee/Administrator, Mylene Bumanlag, and Licensee, Jennifer Kim. Mr. Michael Kim was also present during today's visit.

An application was submitted to Community Care Licensing Department (CCLD) on 1/12/23, for a Change of Ownership for an Adult Residential Facility to serve Developmentally Disabled Adults for ages 18-59 years. The requested capacity is for four ambulatory clients and (2) non-ambulatory clients. There are currently 5 clients in care.

Structure: Facility is a four (4) bedroom, three (3) full bathrooms, single story house, with a detached garage. Detached garage has been converted to be used as office space. There is a kitchen, dining area, laundry room, and 2 living room areas. Front and backyard landscape are in good condition and free of obstruction or debris. Rear patio is covered and provides shading. Patio furniture, which consists of a table and (5) chairs. Signal System : No signal system in facility. Bedroom Residents: The three (3) client bedrooms each consists of (2) two twin beds with proper bedding, including mattress pads, a dresser, night stand, proper lighting in addition to a lamp, and a chair. Bedrooms contain ample closet space. Bedroom Staff: There is (1) one staff bedroom to be used by live in staff. Bathrooms: (3) full bathrooms are available for resident use. Water temperature measured 113.8 degrees F in bathroom #1, 116 degrees F in bathroom #2, and 116.2 in bathroom #3. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, a pillowcase, a mattress pad, a fitted sheet, a blanket and a bedspread. Adequate supply of linen is stored in hallway closets. Emergency Phone Numbers, Personal Rights, Visiting Policy, Exit Plan, & Menu: Emergency Disaster Plan, Personal Rights, Visiting policy, emergency numbers, and menu are posted and readily available for review in dining room area. Facility has a land line telephone located in the living room dining area. One (1) fire extinguisher is located in the dining area and is fully charged. Activity Supplies: sufficient activity supplies were observed.