Facility Evaluation Report

Licensing Program Analyst (LPA) Janira Arreola, conducted an announced visit to the facility for the purpose of a pre-licensing inspection. LPA Arreola identified herself and met with facility Administrator, Marites Boyer, who was informed of the purpose of the visit. At the time of the visit there were (5) staff and (14) clients present.

LPA conducted a walk-through of the facilities interior and exterior. LPA observed that the facility was a single story building with (13) client bedrooms and (2) staff bedrooms, making 15 bedrooms total. The facility has shared restrooms connecting the client bedroom, making (10) bathrooms total. LPA observed and walked through (12) out of (13) client bedrooms due to one client being asleep in their room. LPA observed a sink in each client's bedroom with a shared toilet and shower. LPA observed required furniture such as, chair, lighting, closet space, and bed in all observed rooms. LPA observed hygiene supplies in client bedrooms and bathrooms, including body soap, shampoo, tooth brush, and toothpaste. LPA observed a locked closet designated for cleaning and hygiene supplies, and a closet with extra linens. LPA observed facility laundry room in the east wing of the facility with locked cleaning supplies. The kitchen was observed to have enough plates, cups, cooking pots and pans, as well as eating utensils for the capacity of 15 clients. LPA observed 6 refrigerators and freezers at the facility with the required 2- day supply of perishable foods. LPA observed storage closet with 3 bins full of emergency supplies, as well as the required 7-day supply of non-perishable foods. The facility also possessed sufficient paper supply in storage closet with paper towels, and toilet paper. LPA observed and went through facility first aid kit, and observed emergency flashlights in the facility common areas. LPA observed locked medicine cart with client medication made inaccessible with a lock. LPA walked through the back parking lot as well as communal area where shade was observed with umbrella and trees. The facility possessed enough seating for the capacity of (15) clients in both indoor dinning area and outdoor spaces. Facility client files and personnel files were observed to be in place. The plan of operation was reviewed as well as the emergency and disaster plan (LIC610E) which had been previously submitted to the department. LPA advised Administrator to have this readily accessible at the facility. The facility does not posses any bodies of water or firearms, weapon, or ammunition that would need to be secured.

Component III presentation was conducted and completed at the time of the visit with Administrator and LPA.

There were no deficiency issued at the time of the visit. An exit interview was conducted where this report along with LIC9102TA form was reviewed and provided to facility Administrator, Marites Boyer.