Facility Evaluation Report

Licensing Program Analysts (LPAs) Ruth Martinez and Hanna Gough conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at facility was greeted and granted entry. LPA met with Benjie Dizon, applicant.

An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden resident was submitted to CCL on 04/30/24.

The facility is a two story house with an attached garage with 6 resident bedrooms, 1 staff bedroom, 3 full bathrooms downstairs, a living room, a dining room, a kitchen on the first floor. The second floor of the facility will be occupied by licensee with one bedroom, a living room and 1 full bathroom. Staircase has a locked door for inaccessibility to resident, no resident will reside on the second floor. The resident’s bedrooms on the first floor are spacious and will easily accommodate the resident’s furnishings. There is shaded seating areas for resident and an exit walkway on each side of the house. There is resident shaded seating on the front yard of the facility that is enclosed with a gate. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with all room being private bedrooms. Resident bedroom in the main entry of the facility has its own bathroom. Bedrooms Staff: There is a bedroom designated for live in caregiver. Bathrooms: Facility has three full bathrooms on the first floor. All bathrooms have a working toilet, wash basin, walk in shower. Linens & Hygiene Supplies: Adequate supply of linen in storage located in bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one