Facility Evaluation Report

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility at 1:30pm and was greeted and granted entry by designated Administrator (AD) Jeremias Jabonero and Licensee Janice Jabonero. An application to operate an Adult Residential Facility (ARF) for (4) capacity, (4) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 03/27/2023.

The facility is a one-story home with four resident bedrooms, two full bathrooms, living room, kitchen, dining room, garage and backyard. The backyard has two shaded seating areas. LPA observed posted See Something, Say Something poster. There are two outdoor exit gates accessible on either side of the facility.

All resident bedrooms had the required furnishings. LPA observed all windows were screened

Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored in the garage in a locked cabinet.

Medications, First-Aid Kit & Book: Medication will be stored in a locked cabinet in the kitchen with the First Aid Kit and Book. The first aid kit has all the required elements.

Resident & Staff Files: Records will be kept in the medicine cabinet in the kitchen

Fire Extinguisher: LPA observed one fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. LPA observed a service tag on the fire extinguisher which indicates the fire extinguisher was last serviced on 4/26/23.