Facility Evaluation Report

Licensing Program Analyst (LPA) Lydia Martinez conducted a visit to the facility to conduct an announced Pre-Licensing evaluation. Upon arrival, LPA met with Applicant Adoracion Mauricio. An initial application to operate an Adult Residential Facility (ARF) was submitted to the Central Applications Unit (CAU) on 04/12/2021 for a capacity of 6 non-ambulatory clients. The Fullerton Fire Department conducted a Fire Safety Inspection on 06/09/2021 and granted a Fire Clearance. A tour of the physical plant was conducted inside and out at approximately 9:40 am with Mrs. Mauricio and the following was observed:

Facility is a one story house with 5 bedrooms and 3 bathrooms. Bedroom #1 through #4 are designated as client bedrooms and are authorized for non-ambulatory client use. There is a living room, dining area, office and kitchen. Staff bedroom is #5.

Central air/heating system installed with a central panel to control entire house.

The client bedrooms( #1-#4) accommodate clients' furnishings and meet Title 22 regulation at this time.

The 3 bathrooms have a working toilet, wash basin, and shower. Grab bars and non-slip mats were present.

Adequate supply of linens and hygiene items were observed

Ombudsman Poster, Personal Rights and See Something Say Something Poster

Ombudsman poster will be obtained once licensed, Personal Rights and See Something Say Something were posted.

Adequate supply of 7-day non-perishable and 2 day perishables will be stored in the kitchen and pantry and will include fruits and vegetables.