Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert and Hanna Gough made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs met with Licensee Consolacion Burgos. An application to operate an Adult Residential Facility (ARF) was received by our agency on December 4, 2024 for a total capacity of four; four ambulatory only.

The facility is a one story home with four client bedrooms, three bathrooms, a living room, a kitchen, a dining area, an activities room, and an attached two car garage. LPAs observed two fire extinguishers, one in the dining room and one at the end of the hallway. LPAs observed that they are fully charged and serviced. The front door has an alarm notification when exiting. There is a backyard exit gate on the side of the house that is self-latching and unlocked. There is a shaded seating area and LPAs did not observe any obstacles or hazards in the backyard. LPAs observed the See Something, Say Something poster (PUB 475), Personal Rights, Visiting Hours and Emergency Disaster Plan in the facility mounted on the wall in the dining and living area. Client bedrooms had the required furnishings. LPAs observed that the water temperatures were ranged between 107 and 109.1 degrees Fahrenheit in three of three bathrooms. LPAs observed all beds had linens and blankets. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink or in the garage in locked cabinets. Medications will be stored in a locked cabinet located in the kitchen. The first aid kit is stored in the locked shelving unit in the living room and has all the required elements. Reading materials and games were observed in the living room with a phone for client use. A supply of seven-day non-perishable food was observed and will be maintained on hand. Licensee will provide two-day perishables upon receipt of clients in care. Smoke detectors and carbon monoxide detectors tested operational. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational.

LPAs conducted the Component Three Orientation with licensee. Licensee was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to Licensee.