Facility Evaluation Report

Licensing Program Analyst (LPA) Hanna Gough conducted an announced visit to the facility for the purpose of a pre-licensing inspection. LPA arrived at the facility and was greeted and granted entry. LPA met with applicant Alberto Chavez and Grace Nguyen.

An initial application to operate a Residential Facility for the Elderly for six non-ambulatory of which four can be bedridden and a hospice waiver for six was submitted to CCL on October 21, 2024.

The pending facility is a one story home with a kitchen, living room, attached two car garage, five resident bedrooms, four resident bathrooms and a backyard. LPA observed the garage is locked and made inaccessible. The kitchen is clean and free of debris and vermin. LPA observed a seven day food supply ready and on hand. LPA observed the emergency food and water supply located in the kitchen and in the garage. LPA observed the knives to be locked in a kitchen drawer located by the dishwasher. LPA observed chemicals and toxins to be locked and stored under the kitchen sink and in the locked garage. LPA observed resident bedrooms to have all the required components and furnishings. LPA observed extra storage space for resident use. LPA observed the bathrooms to have toilet paper, paper towels and non-slip mats. LPA tested the water to be 107.2 to 120.0 degrees Fahrenheit. LPA observed the facility had extra clean linens in the closet located by the front door. LPA observed the centrally stored medication will be in a locked closet located in the hallway. LPA observed the facility first aid kit had all the required components. LPA tested smoke and carbon monoxide detectors and they were found to be operational. LPA observed the backyard to have a shaded seating area for resident use and was free of obstructions. LPA observed two fire extinguishers located in the kitchen charged and with a purchase date of June 10, 2024.