Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived on an announced on 1/22/24 at 9:00am and met with Applicant Robert Hernandez and Francis Bagasan, Program Director and stated the purpose of the visit. This visit is to conduct a Pre-Licensing Inspection. LPA was allowed entry into the facility that will be licensed and fire cleared for a capacity of 30 clients of which 10 maybe Non-ambulatory. Administrator certificate expires for Francis Bagasan on 5/9/24. LPA observed that the facility has submitted a Infection Control Plan.

LPA and Robert Hernandez and Francis Bagasan toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed the kitchen area, quiet area, bathroom(s), activities room(s) and storage areas. LPA observed knives/sharps area to be locked. LPA observed required furniture, and lighting throughout the facility. The hot water temperature measured at 110.04*F which is within the required range of 105-120*F. The temperature inside the facility measured at 68*F which is within the required range of 68-85*F.

The facility is not providing meals to clients but in cases where food is needed the facility will contact the clients home. The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

LPA observed centrally stored medications area to be locked. LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s). Facility has central heating and air. LPA observed the area where the staff and resident files will be locked and readily available for review.

Component III conducted - There are no objections to licensure at this time. -Licensure pending.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no violations cited during this visit. An exit interview was conducted and a copy of this report was provided.