Facility Evaluation Report

Licensing Program Analyst (LPA) Dwayne Mason Jr. and Licensing Program Manager (LPM) Armando Lucero made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA & LPM arrived at the facility at 1:50pm and were greeted and granted entry by designated Administrator (AD) Thien Luu and Direct Service Provider (DSP) Max Nguyen. An application to operate an Adult Residential Care Facility (ARF) for (4) capacity, (4) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 6/9/2023.

Structure: The facility is a one-story home with four client bedrooms, two bathrooms, living room, kitchen, dining room, an attached two car garage and backyard. The garage is utilized as both storage and an office space for staff. LPA observed a lock on the garage door to prevent client access. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in one of the hallways. There is a back yard with two exit gates on each side of the house. There is one shaded seating area in the backyard. LPA did not observe any obstacles or hazards in the backyard. LPA observed a fireplace covered by an appropriate screen in the living room.

Client Bedrooms: All client bedrooms have the required furnishings. LPA observed all resident beds have linens and blankets. LPA observed all windows were screened.

Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and are stored and locked in cabinets under the kitchen sink.

Medications, First-Aid Kit & Book: Medication is stored in a locked cabinet in the kitchen. First aid kit is stored with the medication. The first aid kit has all the required elements.

Resident & Staff Files: Records are kept locked in the garage.