Facility Evaluation Report

Licensing Program Analyst (LPA), Samer Haddadin conducted an announced pre licensing visit due to a change of ownership. Facility is to operate an Adult Residential Facility for Persons with Special Health Needs (ARFPSHN). Licensed for four (4) non ambulatory capacity which four (4) maybe bedridden. LPA arrived at the facility met with licensee Ray Libang. LPA was granted entry and explained the reason for the visit.LPA requested to review the client's roster and LIC 500. LPA reviewed the facility file prior to the visit. At the time of the visit there were three (4) client’s in care; LPA reviewed whether the following is in compliance licensee is operating the facility within the conditions and limitations specified on the license, including the capacity limitation. LPA conducted the tour inspection of the inside and outside of the facility; all outdoor and indoor passageways, other areas of potential hazard and obstructions were inspected. All client’s bedrooms were inspected. All lift tracking device were inspected and operating to all client's bedrooms and bathrooms. All client’s personal hygiene supplies were inspected and available. There are no bodies of water observed. Wired smoke detectors and carbon monoxide were tested and operational. Generator is manually tested every Monday per administrator. Fire drill was conducted last 02/7/2025 per review of the facility fire drill log book. Two (2) full fire extinguishers were observed and inspected. All toxins and disinfectants were inspected & locked; two-day supply of perishable and seven-day supply of non-perishable foods inspected and available, GTube feeding food supplies available for 2 days and 7 days supply including emergency supplies; LPA observed all medications were labeled and maintained as required and stored inaccessible to the clients by the client's lock drawers. Hot water temperature was recorded to be 109.2 degrees and the room temperature was recorded to be 75F degrees. LPA did not observed any camera's installed in the facility.The Administrator 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 the report was provided to Licensee.