Facility Evaluation Report

Licensing Program Analysts (LPAs) Kimberly Lyman and William Vanegas made an announced visit to conduct a pre-licensing inspection. LPAs identified themselves and discussed the purpose of the visit with Licensee Jessica Garcia. An initial application to operate an Adult Residential Facility for Persons with Special Health Needs was received by Community Care Licensing on 03/20/2024 for a capacity of five bedridden clients. Upon entry, facility appears clean, safe and sanitary. Administrator Aisa Guiling has an administrator certificate expiring on 04/28/2026.

LPAs along with Licensee toured the facility at 7:48 AM and observed the following:

Structure: Facility is a one story, 5 bedroom, 2 bathroom house with a tan exterior and a detached garage. The outside exit gate is closed, unlocked and self-latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Clients: Rooms will be single occupancy. All rooms are equipped with appropriate lighting, night stand and ample closet space. Linens & Hygiene Supplies: Facility has bedding and towels in supply. Bathrooms: All client bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted in the hallway of the facility. Food Service: Facility has 2 day perishables as well as 7 day non-perishables. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguisher is fully charged.. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : Facility has secured areas for toxins and sharps. Water Temperature: Tested and recorded between 115.3 and 118.9 degrees F. in facility bathrooms. Emergency Supplies: LPAs observed ample emergency food and water as well as a posted emergency disaster plan.. Medications, First-Aid Kit & Book: First aid kit observed contained all required items including tweezers, scissors and thermometer. LPA observed a first aid manual. Medication is stored in a locked cabinet and medication carts. Facility to use a medication administration record. CONTINUED ON LIC 809C DATED 10/30/2024