Facility Evaluation Report

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection for a change of ownership. LPA arrived at the facility and was greeted and granted entry by designated Administrator (AD) Deborah Seifert. An application to operate a Adult Residential Facility (ARF) for (6) capacity, (6) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 6/26/2023.

Structure: The facility is a one-story home with three resident bedrooms, two bathrooms, living room, kitchen, dining room, staff room, backyard and attached two car garage. There are two exit gates in the back yard. The backyard has a seating area.

Client Bedrooms: All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. LPA observed facility has additional chairs in garage if residents would like to use them.

Bathrooms: The bathrooms have working plumbing. Hot water measured at 110.6 degrees Fahrenheit in the common bathroom and 105 degrees Fahrenheit in the bathroom in the staff room which residents use if necessary.

Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored under the kitchen sink and in cabinets in the garage.

Medications, First-Aid Kit & Files: Medication and first aid kit will be stored in a locked cabinet near the kitchen. Records will be kept in a cabinet in the dining room.

Fire clearance: Was approved by a fire inspector of Anaheim Fire Department on 7/19/2023.