Facility Evaluation Report

Licensing Program Analyst (LPA) Anna Bueno conducted an announced visit to complete a pre-licensing inspection for a change of facility type application. LPA Bueno identified herself to licensees Teresa and Kish Damaso and informed them of the purpose of the visit.

The facility has a Residential Care Facility for the Elderly (RCFE) license and is currently applying for licensed Adult Residential Facility. The facility has been granted a fire clearance on 11/06/2023 by the Fontana Office for a total capacity of 6 clients, 5 of which may be nonambulatory.

LPA Bueno and Licensees toured the interior and exterior of the facility. The facility has five client bedrooms, three and a half bathrooms, kitchen, a living/sitting room, dining and activity area, and backyard. The facility has no bodies of water. A covered patio allows for ample seating and recreational outdoor activities. LPA observed that side gate was unlocked and free of obstruction. The facility has a working telephone. LPA observed charged fire extinguishers while combination smoke and carbon monoxide alarms were tested and found to be in working order. The facility keeps a complete first aid kit and manual. A locked centralized storage area for medications and client and staff files was observed.

The following were observed of the physical plant:

Client Bedrooms: LPA observed all bedrooms to have the required bedding and furniture, such as, clean mattresses/linen, sufficient storage space, chairs, and lighting.

Client Bathrooms: LPA observed all bathrooms and fixtures are kept in sanitary conditions. LPA observed night lights were maintained in the hallways near bathrooms.

Dining Area and Kitchen: LPA inspected the kitchen and found dishes, glasses, and utensils were in good working order. The dining table, kitchen countertop, appliances, and floors were free of debris. Cleaning supplies are secured and sharps are locked separately from other supplies. LPA observed appropriate food provisions. Sample menu is available for review.

Activity Area and Living Room: LPA observed adequate seating in the common areas. The facility had a supply of activities and reading materials for individuals served. Planned weekly activities was reviewed by.