Facility Evaluation Report

Licensing Program Analyst (LPA) Ramon Serrano, conducted an announced Pre-Licensing inspection. LPA met with Licensees Gil and Jane Antonio and we discussed the purpose of the visit.

LPA conducted a tour of the facility, both inside and outside. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for client use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, curtains and paint throughout the facility, was observed in good condition. Each room intended for client use had the appropriate furniture, bedding and appropriate lighting. Gil and Jane Antonio stated there are no firearms stored on the premises.

Hot water temperature was measured in the facility at 110 degrees F. The ambient temperature inside the facility was measured at 71 degrees F. The facility was observed to be clean and kempt with no strong malodors. The refrigerator and freezer was observed to be clean and operational, with an ample amount of food to meet client needs. Cleaning solutions were also properly secured in the garage area.

The Component III portion of the application process was completed with Licensee's Gil and Jane Antonio on today's date as well.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Gil Antonio and a copy of this report along with Licensee Rights (LIC 9098, 01/16) was provided to Gil Antonio whose signature below verifies receipt of these rights.