Facility Evaluation Report

Licensing Program Analyst (LPA) Bethany Mirlohi arrived to conduct a pre-licensing inspection. LPA met with licensee Criselda Centeno during today's visit. Currently there are no clients residing within the facility.

Facility was inspected both indoors and outdoors. LPA inspected 4 client bedrooms, 3 bathrooms, 1 staff office, common living areas, garage and kitchen. Outdoor area is free from hazardous debris. Outdoor exits are clear and accessible. Licensee has purchased an outdoor patio set with a shade covering, and it will be delivered prior to client move in. First aid kit was present in the facility. Centrally stored medications will be locked in the staff office. The facility has adequate lighting throughout. Water temperature was observed at 114 degrees F. LPA inspected client bedrooms and the bedroom had appropriate furnishings, chair, adequate lighting and storage. Bathrooms are clean, sanitary, and in good repair. Smoke detectors and carbon monoxide detectors were operational. Fire clearance was granted on 05/18/2023 for 4 non-ambulatory clients. Kitchen is clean, sanitary, and in good repair. A working telephone has been set up for client use.

Licensee agrees to notify LPA once first consumer is admitted. This report will be forwarded to the centralized application unit for continued processing. COMP III was waived.

Exit interview and copy of report provided.