Facility Evaluation Report

On 6/19/2024, Licensing Program Analyst (LPA), Janette Romero made an announced visit to conduct a pre-licensing evaluation and met with Applicant, Roy Martin and Administrator, May Embalsado. A change of ownership application to operate a Adult Residential Facility (ARF) was received by the Centralized Applications Bureau (CAB) on 2/13/2024. Fire Clearance was granted on 1/12/2024 for a total capacity of four (4) non-ambulatory clients. During today's visit, there was one (1) staff present and LPA was informed the client currently residing in the facility was out in the community.

LPA toured the facility with Applicant Martin and Administrator Embalsado. During the tour, LPA observed the facility is made up of a one (1) story home with three (3) client bedrooms, two (2) bathrooms, a staff room, kitchen, dining room, living room, and attached garage. The facility has a central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Administrator Embalsado tested one (1) of the smoke alarm/carbon monoxide detectors and LPA observed it to be operational. The facility has fire extinguishers mounted throughout the home, serviced on 4/26/2024. Client bedrooms are each furnished with a bed, chair, and night stand. Both bathrooms have a working toilet, wash basin and have paper towels, toilet paper, and soap readily available. The facility has additional clean towels and linens stored in a hallway cabinet. LPA toured the kitchen and observed the knives and sharp instruments stored in a kitchen cabinet secured with a master lock. Cleaning solutions and disinfectants are secured in a locked cabinet in the garage. The facility has an emergency water supply along with incontinent supplies stored in the garage. LPA observed the stove to be operational. Refrigerator/freezer are in working condition. The facility has more than a 2-day supply of perishable foods and 7-day supply of non-perishable foods. There is adequate seating for meals for the approved capacity. Medications are secured in a storage cabinet in the dining room. There is a swinging self-latching gate on the right side of the property. Indoor and outdoor pathways are free of obstructions. There was no bodies of water observed on the premises.

During today's visit, LPA did not observe any issues or concerns. Applicant Martin reported they attended COMP III on 6/14/2024 at the Riverside Regional Office. Final approval of licensure will be granted by CAB.