Facility Evaluation Report

Licensing Program Analyst (LPA) Lydia Martinez and Nurse Anna Guinto made an announced visit to the facility for purpose of conducting a Pre-Licensing inspection. LPA Martinez and Nurse Guinto arrived at the facility and met with designated Administrator (AD) Martin J. Lopez. An initial application to operate an Adult Residential Facility (ARF) for a capacity of (6) non-Ambulatory was received by CCL on 03/23/2021. This is a conversion from an Intermediate Care Facility (ICF) to an Adult Residential Facility (ARF). There are currently 4 clients in care under current license.

Structure: The facility is a one story home with five bedrooms, two bathrooms, living room, kitchen, dining room, and an attached two car garage that is used for storage. There is a back yard with an exit gate on one side of the house. There is a shaded seating area in the front yard with patio table and chairs. LPA did not observe any obstacles or hazards in the backyard. Client Bedrooms: All client bedrooms have the required furnishings. LPA observed all client beds have linens and blankets. Bedrooms Staff: Facility has live-in staff. Bathrooms: Bathrooms have working plumbing and designated hand washing posters. Hot water in bathrooms is within regulatory requirements. Signal system: There is no signal system. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to the clients. Toxins are stored in locked garage and locked under kitchen sink cabinet. Linens & Hygiene Supplies: Supply of extra linen are stored in hallway closet. Emergency Phone Numbers, Exit Plan & Menu: Posted and available for review were Emergency Disaster Plan with means of exiting and Emergency phone numbers listed. Menu was posted and visible. Food Service: Facility has a supply of 2-day perishable and 7-day of non-perishable food on hand for clients present. Smoke Detectors: Smoke detectors and Carbon Monoxide detectors are centrally wired and operational. Appliances: Gas stove with oven, refrigerator, dish washer, microwave, washer, and dryer are operational.