Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility and was greeted and granted entry. LPA met with Rowena Carrillo, Applicant/Administrator and explained the visit.

A change of ownership application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden resident was submitted to CCL on 08/03/23.

The facility is a one-story house with an attached garage with 6 resident bedrooms, 3 full bathrooms, a living room, a dining room, and a kitchen. The residents’ bedrooms are spacious and will easily accommodate the residents’ furnishings. There is a large back yard with a closed patio and one exit walkway on one side of the house with seating for the residents.

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

Bedrooms will accommodate 6 residents with 6 private rooms. Bedroom 6 has a full bathroom. Bedrooms Staff: No bedroom designated for wake staff. Bathrooms: The facility has three full bathrooms. All bathrooms have a working toilet, wash basin, and walk-in shower. Linens & Hygiene Supplies: Adequate supply of linen in closet storage in main living room. 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 week prior and listed for food served for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the