Facility Evaluation Report

Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Licensees Juliana and Tusitino Sauvao. An application to operate an Adult Residential Facility Level 4i was received by our agency on February 29, 2024 for a total capacity of four ambulatory clients.

The facility is a one story home with four client bedrooms, two bathrooms, a living room, a kitchen/dining area, and an unattached two car garage. All exiting doors had alarm notifications. There is a backyard exit gate on the side of the house that is self-latching and unlocked. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. LPA conducted testing of hot water temperature in two of two client bathrooms . The hot water temperature measured between 118.4 and 120.0 degrees Fahrenheit and all smoke detectors were operational . The fire extinguisher is charged and was serviced on April 4, 2024. LPA observed the See Something, Say Something poster (PUB 475), Personal Rights, Visiting Hours and Emergency Disaster Plan in the facility mounted on the wall in the living room area. Client bedrooms had the required furnishings. LPA observed all beds had linens and blankets. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to clients and will be stored and locked in the garage. Medications will be stored in a locked cabinet. The first aid kit is stored in the cabinet and has all the required elements. Reading materials, sensory items, puzzles and board games were observed in the living room with a phone for client use. A supply of two-day perishables and seven-day of non-perishable food was observed and will be maintained on hand. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational.

LPA conducted the Component Three Orientation with Licensees and the licensees were 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 this report was provided to Licensees.