Facility Evaluation Report

Licensing Program Analyst (LPA) Tung Truong conducted an announced pre-licensing inspection visit on 7/13/2022 at 1:30 PM. LPA met with Rochelle Cister, Applicant/Administrator and explained the purpose of today’s visit. The facility will be licensed for a capacity of 4, 1 non-ambulatory client and 3 ambulatory clients.

Administrator Rochelle Cister holds a current certificate # 6050060735 which will expire on 11/26/2022. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to clients.

LPA observed the facility common areas were clean and furnished. There were no clients in care at this time. The temperature inside the facility was observed to be at 78*F which is within the required range of 68-85*F. The hot water temperature was measured and is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility were in good repair. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit was up to date. LPA observed no obstruction of emergency exits inside or outside of facility.

Based on a review of this facility during this pre-licensing visit, it was determined that this facility was found to be in compliance at this time. Administrator Rochelle Cister has completed Component III before and therefore waive this requirement. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed or cited. Exit interview held, copy of report given.