Facility Evaluation Report

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an announced pre-licensing inspection at the home and met with Applicant, Roy Martin, and Administrator, May Embalsado.

Application : The application is for an Adult Residential Facility (ARF), change of ownership. The fire clearance has been granted for six (6) non-ambulatory clients. Buildings and Grounds: The home is composed of four (4) client bedrooms, one (1) staff room, two (2) living bedroom areas, two (2) bathrooms, a laundry room, kitchen, two (2) dining areas, a garage, and front and back yard areas. The interior and exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors are in working order. There are no pools or other bodies of water located at the home. According to the applicant, there are no weapons stored in the home. Rooms, furniture, and beds appeared to be in good repair. The bedrooms are fully furnished, and privacy is available. The dining and living room areas are clutter free and in good condition. Outdoor areas had sufficient room for activities and leisure. A washing machine and dryer were available and in working order. The home is in good condition. Storage and Supplies: Medications will be stored in a locked cabinet, inaccessible to any unauthorized individuals. Secured areas are available for facility files, staff files and client files. A complete first aid kit was observed to be available. Cleaning supplies will be stored away in a secured location. Linens, and equipment appeared to be in good repair and sufficient for the approved census. Fire extinguishers were available and fully charged.

Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps will be stored in a locked cabinet, available only to authorized individuals. Forms: The following signs were observed to be posted at the home: Emergency Disaster Plan (LIC 610D), Personal Rights, and Facility Sketch (LIC 999).

No corrections were observed to be needed at time of inspection. The LPA will inform the Centralized Applications Bureau (CAB) the home is ready for licensing. This report was discussed with, and a copy provided to Applicant, Roy Martin.