Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Hood met with applicant, Jeffrey Stewart, to conduct a Pre- Licensing visit. The facility has a fire clearance for 6 ambulatory clients. Applicant holds a current administrator certificate (#6032613735 with expiration date 8/26/2022).

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are three (3) bedrooms and two (2) bathrooms for client use, along with one (1) bedroom for staff. LPA observed facility to be properly furnished, including appropriate bedding and lighting in bedrooms. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 117 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to clients. LPA observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguisher and first aid kit are maintained and ready for emergency use.

LPA observed during visit that debris should be cleared from backyard area, Say Something poster should be sufficient size and posted in common area, non-slip mats should be placed in bathroom, and scissors and thermometer should be included in first aid kit. LPA indicated all the above observations need to be fixed and facility will send corrections to CCLD within 7 days from today's date.

Pre-licensing passed and Component III completed. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval once requested items have been received. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.