Facility Evaluation Report

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a pre-licensing inspection. LPA met with Applicant and explained the purpose of the visit

Today's visit, LPA and Applicant conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: three clients room, three staff room, kitchen, laundry, backyard and the common areas. LPA observed the facility to have at least two days of perishable and seven days of nonperishable food. LPA observed facility to have operable carbon monoxide and fire alarms. LPA observed the exterior to be free of obstruction in pathway. LPA observed medications, sharps and toxins to be locked and inaccessible to clients in care.

LPA and Applicant d iscussed the following : CCR 85068.4 Acceptance and Retention Limitations and 80024 Waivers and Exceptions.

File review of four clients file, LPA observed the required documents to be present. Inspection tool completed and no correction needed.

Comp III was waived as Applicant is the administrator for other adult residentials.

Licensure is pending approval from Central Application Bureau (CAB). CAB analyst will contact Applicant with a copy of license once approved.