Facility Evaluation Report

Licensing Program Analyst (LPA) Andrea Mendivil made an announced visit to conduct a pre-licensing inspection. LPA identified themselves and discussed the purpose of the visit with Administrator Maxine Kniazeff. Licensee Elizabeth Santos arrived at 9:20 AM. An initial application to operate an Adult Residential Facility was received by CCL on 10/13/2022 for a capacity of six ambulatory clients. Facility has a screening area in the entrance of the facility.

LPA Mendivil along with Licensee and Administrator toured the facility at 9:25AM and observed the following:

Structure: Facility is a single story, 6 bedroom, 2 bathroom and 1 office space house with a terracotta exterior. Facility has an attached secondary office which contains 1 bathroom and access to the garage. The exit gate is unlocked and self latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Dining room contains a fireplace which has a cover. Bedrooms Residents: All client rooms are single occupancy, All of the rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Client bathroom has a working toilet/ wash basin. Facility has sanitizer and paper towels in the restrooms . Linens & Hygiene Supplies: Facility has bedding and towels for clients in care. Emergency Phone Numbers and Exit Plan: Posted in entrance of facility. Food Service: Licensee has 2 day perishable and 7-day nonperishable foods. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested and operational. Fire extinguisher present in kitchen of facility. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : LPA observed a secure area for sharps and toxins. Water Temperature: LPA tested hot water and it read as following: client bathroom read at 113 degrees, bathroom #2 read at 107.4 degrees and kitchen read at 113.5 degrees. Emergency Supplies: LPA observed supply of emergency water and food. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. CONTINUED ON LIC 809C DATED 12/5/2022