Facility Evaluation Report

Licensing Program Analyst (LPA) Carmen Lopez conducted an announced Case Management visit for a Change in Ambulatory Status. LPA identified herself and was granted entry by Candy Chong, Licensee. LPA met with Licensee Chong and disclosed the purpose of the visit.

The facility has requested a change from 6 – ambulatory clients to 6 clients of whom 2 – ambulatory, 3 – non-ambulatory, and 1 - bedridden clients reside at the facility. A fire clearance was granted by the local fire authority on May 24, 2022 and received by Community Care Licensing (CCL) on June 7, 2022. During today's visit, LPA toured the facility, and observed clients in care. As of today, there are six (6) clients in care all of whom are ambulatory at this time.

During the tour of the facility, LPA observed each clients bedroom and bathroom. During the tour, LPA observed the physical plant and residents' accommodations including furnishings, linens and personal hygiene items; resident bathrooms are equipped with cleaning products; toxic substances are stored in a locked cabinet in the garage; medication storage and administration logs are located in a locked cabinet located in the kitchen area; sufficient space to conduct activities was present; facility posting requirements were present in a common area; the facility administrators certification was current; no pool or other body of water is present on the facility grounds; per the Administrator there are no guns, weapons or ammunition located on the property. No deficiencies were issued during this visit.

An exit interview was conducted with Candy Chong, Licensee. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided at the conclusion of the visit. The signature below serves as confirmation that the documents were received.