Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza made an Announced visit and met with Regional Operations Director Nicole Collar, Administrator Steven Rodriguez, and Home Supervisor Susann De La Torre to conduct a Pre-Licensing evaluation.

An application was submitted to Community Care Licensing Department (CCLD) for an initial application of an Adult Residential Facility (ARF) to serve developmentally disabled adults ages 18-59. The home will be a level 4N Adult Residential Facility (ARF). The total requested capacity is for four (4) residents [three (3) bedridden and (one) non-ambulatory].

Structure: The facility is a single story home located in a residential neighborhood that is licensed for three (3) bedridden clients, and one (1) non-ambulatory client. It consists of 4 client bedrooms, 2 living rooms, dining area, kitchen, 3 bathrooms, laundry room, backyard patio area, and a detached garage. Bedrooms : All four (4) bedrooms will be private. Bedrooms are equipped with one bed, night-stand, chair, lamp, and overhead lightning. Bathrooms: Have a working toilet, wash basin, and bathtub. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens are stored in facility closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. Three (3) fully charged fire extinguishers are in place. Facility has an operable land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Smoke Detectors : There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. There are several carbon monoxide detectors in the home. Appliances: Refrigerator , oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff.