Facility Evaluation Report

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Tawfik Faten Fouad, discussed the purpose of the inspection, and toured the facility. Facility is to operate an Adult Residential Facility. Application was submitted to Community Care Licensing on 05/13/2022. This is an initial inspection with no persons in care. There were no residents present during the inspection.

During the inspection, LPA and AP observed the following: Structure. This is a one-story home. Facility is a 4-bedroom, 2-bathroom, home with attached garage that is being used for storage. There is a back yard with a patio cover for the residents. Facility telephone number is (714) 395-6956. Resident Bedrooms. The 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lamps, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms. There are no staff bedrooms. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 108 to 109 F degrees. Linens & Hygiene Supplies. New linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. 7 days nonperishable food supply reviewed. AP stated the facility will obtain 2 days supply of perishable food upon licensure. LPA inspected the fridge and freezer in the kitchen which were observed to be within proper temperatures. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the smoke detectors and carbon monoxide detectors. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen cabinet. Toxins: observed locked under the kitchen sink. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files. This is an initial inspection. LPA observed storage area for staff and resident files. Fire clearance was approved by Anaheim Fire Department Inspector Alicia Badosa on 08/15/2022. Backyard. Backyard exit gate is operational and unlocked. Back yard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. AP will obtain liability insurance once application is approved.