Facility Evaluation Report

Licensing Program Analyst (LPA) Andrea Mendivil made an announced visit to conduct a pre-licensing inspection. LPA identified themselves and discussed the purpose of the visit with Licensee Miriam Salcedo. An initial application to operate an Adult Residential Facility was received by CCL on 07/05/2022 for a capacity of six ambulatory clients. Facility has a screening area in the entrance of the facility.

LPA Mendivil along with Licensee toured the facility at 1:05PM and observed the following:

Structure: Facility is a single story, 4 bedroom, 2 bathroom house with an attached garage and a white exterior. The exit gates are unlocked and self latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room, entrance of facility will be utilized as a meeting room. Living room contains a non-operational fireplace which has a cover. Bedrooms Residents: Rooms # 1 and 2 are single occupancy and rooms # 3 and #4 are double occupancy for clients. All of the rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Client bathroom has a working toilet/ wash basin. Facility has sanitizer and paper towels in the restrooms. Staff bathroom has a working toilet/wash basin. . Linens & Hygiene Supplies: Facility has bedding and towels for clients in care. Emergency Phone Numbers and Exit Plan: Posted in entrance of facility. Food Service: Licensee has 2 day perishable and 7-day nonperishable foods. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested and operational. Fire extinguisher present in entry of facility. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : LPA observed a secure area for sharps and toxins. Water Temperature: LPA tested hot water and it read as following: client bathroom read at 105.5 degrees, staff bathroom read at 106 degrees and kitchen read at 105.2 degrees. Emergency Supplies: LPA observed supply of emergency water and food. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. CONTINUED ON LIC 809C DATED 10/21/2022