Facility Evaluation Report

At approximately 1:00PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility for the purpose of completing a pre-licensing evaluation. LPA met with Applicant Deyra Tambot-Sunga and toured the facility. The Facility is a 4-bedroom, 2-bathroom, single story house. Fire extinguisher was mounted and charged. Smoke detectors were tested and in working order. Carbon monoxide detector was present. There was a locked area for medications and several for toxins and cleaning supplies. Beds were made with appropriate linens. Resident rooms contained furniture as required in 4 of 4 rooms. Hot water temperature was tested and found to be within regulation between 105 degrees F and 120 degrees F at faucets accessible to residents.

A fire clearance for this facility has been granted.

Component III orientation was conducted at facility. Applicant conveyed a good knowledge of Title 22 regulations.

The pre-licensing evaluation has been completed. LPA will submit the application packet for a final review and approval from the Licensing Program Manager.

This report was reviewed with applicant and a copy was provided.