Facility Evaluation Report
On this day, 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 05/20/2024 for a capacity of four (4) ambulatory clients.
LPA Mendivil along with Licensee toured the facility at 1:30PM and observed the following:
Structure: Facility is a single story, 4 bedroom, 2 bathroom house with a detached garage and a grey exterior. The exit gates are unlocked and self latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Living room contains a non-operational fireplace which has a cover. Bedrooms Residents: All bedrooms are single occupancy. 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. 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 108.2 and 109.6 in dual sinks, master bathroom sink read at 111.9 degrees and kitchen read at 106.4 degrees. Emergency Supplies: LPA observed supply of emergency water and food. Medications, LPA observed a locked cabinet in the kitchen for medication. Facility to use a medication administration record . First-Aid Kit & Book: First aid kit observed contained all required items. CONTINUED ON LIC 809C DATED 12/20/2024
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction