Facility Evaluation Report

Licensing Program Analyst (LPA) Rayshaun Nickolas made an announced visit to the facility in order to conduct a pre-licensing inspection for an initial application. LPA identified herself to Administrator, Cielita Ravelo and Licensee’s, Jerry and Violeta Hermogino, who were also advised of the purpose of the visit.

The pending application is for an Adult Residential Facility (ARF). The facility has been granted a fire clearance for a total capacity of four (4) ambulatory clients by the Victorville Fire Department on 03/18/2022. LPA conducted a physical plant tour and observed that the facility is not ready for the prelicensing visit. LPA observed the facility does not have the LIC 610 Emergency and Disaster Plan available at the facility for the LPA’s review. LPA observed the water temperature in the kitchen and bathroom # 1 was 122 degrees Fahrenheit. LPA observed that one pane of the double-pane sliding glass door in the master bedroom is broken.

Ravelo stated that they will take care of all the items that need repair, the water temperature adjustment, and ensuring the LIC 610 Emergency and Disaster Plan will be available at the facility for the LPA’s inspection and review. LPA will reschedule the prelicensing visit with the administrator and the licensees when all items are completed.

An exit interview was conducted where this report was discussed, and a copy of this report was provided to the administrator and the licensees.