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 facility was greeted and granted entry. LPA met with Maricel Nepomuceno, Director and Jeffrey Bencito, Administrator and explained the visit.

An initial 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 01/30/23.

Structure: The facility is a one story house with an attached garage with 5 resident bedrooms, 1 staff bedroom, 4 full bathrooms, a living rooms, a dining room, and a kitchen. The resident’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large back yard with a covered patio and one exit walkway on both sides of the house with seating for the residents. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with 4 private rooms and 1 shared room accommodating two residents. Bedrooms 1, 5 and 6 has a full bathroom. Bedrooms Staff: Bedroom 4 is designated for live-in staff. Bathrooms: Facility has four full bathrooms. All bathrooms have a working toilet, wash basin, walk in shower. Linens & Hygiene Supplies: Adequate supply of linen in closet storage in hallway closet. 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 serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen with surplus goods stored in garage. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested,