Facility Evaluation Report

Licensing Program Analyst, Amber Coleman (LPA) arrived at the J Holly Spring Valley Lake Facility to conduct a pre-licensing visit for initial application. LPA was greeted by Administrator, Lee Johnson (Admin..) and invited inside of facility. LPA introduced self and stated purpose of the visit. LPA was asked to sign in and have temperature taken. LPA observed the COVID station to include PPE, sign in sheets for visitors and appropriate infection control signage. LPA also observed the facility to be free of clutter and in comfortable temperature.

Admin.. and LPA began a walk through of the facility. The facility has been granted a fire clearance on 10/11/2022 by the San Bernadino County Fire Protection District for a total capacity of four ambulatory clients. 0 Bedridden and 0 Non-Ambulatory.

The facility is a 2 story house. It includes a total of 4 bedrooms for each client. 1 bedroom downstairs and 3 upstairs. First floor contains the staff lounge, the kitchen, laundry room, living room and Administrator Office.

Administrator and LPA walked outside of the facility to the backyard. The backyard contains two seated shady areas for residents. The facility has two gates on both sides. LPA observed the gates to be unlocks and in good condition. LPA observed no bodies of water on the premises. Each window around the facility was observed is secure with a proper fitting screen free of insects.

The facility has a number of working landlines accessible to clients. Fire and carbon monoxide alarms were tested and found to be operational. LPA observed the designated closet for medications to be secure.

The following were observed of the physical plant: