Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct a pre-licensing inspection. LPA identified himself and explained the purpose of the visit with Applicant Thien Luu. An initial application to operate an Adult Residential Facility (ARF) was received by CCL on 08/31/2022 for a capacity of four ambulatory clients. Facility is to be vendorized by the Regional Center of Orange County, serving level 4C clients. Facility has no clients at this time.

LPA and Applicant toured the facility. LPA observed the following:

Structure: Facility is a single family one story home with; living room, eat in kitchen, 4 bedrooms, 2 bathrooms and a two car garage. Facility phone number is 714-797-6057. Common Areas : Adequate seating is available in the living room and kitchen. Bedrooms: rooms are single occupancy. All rooms have a bed, chair, night stand, lamp and closet. Bathrooms: Bathroom 1 is in bedroom 1. All bathrooms are clean and operational, grab bars are secure. Both showers have a non-skid mat. Linens & Hygiene Supplies: Facility has ample bedding, towels and hygiene supplies for clients. Emergency Phone Numbers and Exit Plan: Posted in entrance of facility along with Covid-19 postings. Food Service: Facility has 2 day perishable and 7 day non-perishable food supply on hand. Smoke Detectors: Smoke detectors/ carbon monoxide detectors tested operational during today's visit. Appliances: Refrigerator and stove are clean and operational. Toxins / Sharps : Cleaning supplies and sharp objects are locked under the kitchen sink. Water Temperature: Hot water measured 112.6 degrees Fahrenheit in bathroom one and 113.4 degrees Fahrenheit in bathroom two. Emergency Supplies: LPA observed emergency food and water stored in the garage. LPA observed a 30 day PPE supply. Medications, First-Aid Kit & Book: Facility has a first aid kit which contained the required items. Medication will be stored and locked in a kitchen cabinet. Resident & Staff File: Files will be stored in medication cabinet. Reading Material, Games, and Equipment: LPA observed games and reading material and a TV in the living room. Outside areas : LPA observed a shaded outdoor patio area with a table and chairs. No bodies of water observed. The shed in the backyard is kept locked and used for storage.