Facility Evaluation Report

Licensing Program Analyst (LPA) Avelina Martinez and Maja Jensen made an unannounced visit to this facility to conduct an pre-licensing inspection on 01/07/2022 at 9:00 AM. LPA met with Okay Onwuli and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate, and there are 4 residents residing at this facility. LPA Martinez and LPA Jensen toured the facility with Okay Onwuli on 01/07/2022 at 9:30 am.

LPA Martinez is requesting the following:

Sample of Hospice-Binder/Hospice Notification form

As a result of this pre-licensing inspection, the applicant has not passed the pre-licensing component of the application process. LPA Martinez will return at a later date and time to complete the inspection visit. An exit interview was conducted, and a copy of the is report was given to the applicant.