Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Licensee and Administrator (AD) Rosario Dacayo, and Imelda Samonte. An application to operate an Adult Residential Facility (ARF) for (4) capacity, (4) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by CCL on January 08, 2024.

The facility is a one-story house with four client bedrooms, three bathrooms, a living room, a kitchen, a dining room, an enclosed patio, and unattached two car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the dining room. There is a backyard with an exit gate on the west side of the house. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard.

All client bedrooms had the required furnishings. LPA observed all beds had linens and blankets.

All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and will be stored and locked underneath the kitchen sink.

Medication will be stored in a locked cabinet. First aid kit is stored with the medication. The first aid kit has all the required elements.