Facility Evaluation Report

On 12/04/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to this facility to conduct a Pre-Licensing visit. LPA met with applicant, Arabella Mathis and explained the purpose of the visit. The purpose of this visit was to conduct a pre-licensing visit.

Current census was 0. A brief interview with applicant Mathis was conducted.

This facility will hold 3 ambulatory residents in bedrooms #1, #2, and #4 with one non-ambulatory resident in bedroom #3 with a direct exit. This facility also plans to hold and accept Level 4C level Residents from Alta Regional Center.

LPA Pascua initiated a tour of the facility with Applicant, Arabella Mathis. The applicant has an active adult residential administrator certificate #6065286735 and expires on 09/08/2025.

One fire extinguisher was placed in the kitchen and was serviced by River City Equipment Company on 06/21/2024. Smoke detectors and carbon monoxide detectors were located throughout the facility and were observed to be functional and in compliance at this time.

All rooms designated as activity areas and common areas for resident use were toured. Furniture and furnishings were observed to be present and sufficient to meet the needs of the residents at this time.

Office rooms and other areas intended for resident use were toured.

Kitchen area was toured. Facility freezer and refrigerator units were toured. LPA reviewed the food storage supply to make sure that there was always a 2-day perishable and 7-day nonperishable food quantities on site at all times. Knives were observed to be locked and made inaccessible. An additional pantry was identified to store additional non-perishable food supplies.

Storage area for chemicals and cleaning supplies were observed to be locked and made inaccessible to the residents at this time.

A tour of 4 resident bedrooms was conducted. Furniture and furnishings were observed to sufficient and able to meet the needs of the residents at this time. Bedroom #3 was observed to have a direct exit to the back yard.