Facility Evaluation Report

Licensing Program Analyst (LPA) Michelle Reed arrived at the facility to commence an announced Prelicensing visit. Upon arrival, LPA met with Applicant Ahmad Ali. This is a relocation of facility Coastal Home Care #306004788 in San Clemente. An initial application to operate an Residential Care Facility for the Elderly was submitted to the Central Applications Unit (CAU) on 8/30/21 for a capacity of 6 nonabmulatory residents of which 5 will be non-ambulatory and 1 bedridden. The Orange County Fire Authority conducted a Fire Safety Inspection on 9/14/21 and granted a fire clearance. A tour of the physical plant was conducted inside and out at approximately 11:20 am. with Mr. Ali and the following was observed:

Facility is a one story house with 7 bedrooms and 3 bathrooms. Bedroom #1 through #5 are designated as resident rooms and are authorized for non-ambulatory resident use. Bedroom #1 will be used for the bedridden room. There is also a living room, dining area and kitchen. Staff rooms are Rooms #6 and #7.

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

The resident bedrooms( #1-#5) accommodate residents' furnishings and meet Title 22 regulation at this time.

Bathrooms have a working toilet, wash basin, and shower. Grab bars and non-slip mats were present as well as soap, paper towels and toilet paper.

Adequate supply of linens and hygiene supplies were observed

Ombudsman Poster, Personal Rights and See Something Say Something Poster

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