Facility Evaluation Report

Licensing Program Analyst (LPA) Ramon Serrano conducted an announced Case Management visit. LPA met with Administrator Sylvia Freeman and discussed the purpose of the visit.

A Change of Capacity application was received by Community Care Licensing (CCL) on December 7, 2023, in which the licensee requested a decrease in capacity from six to four clients. The Fire Safety Inspection Request, dated December 12, 2023, was approved by the local fire authority on March 26, 2024. The approval was received by CCL on March 26, 2024.

During today's visit, LPA conducted a tour of the facility, accompanied by Sylvia Freeman, and observed no immediate health or safety concerns. The facility sketch/floor plan was consistent with the current layout and accommodations at the facility. It should be noted that the "decrease in capacity" visit was originally conducted on April 3, 2024. The visit had to be conducted again since the facility census was six (6) clients at the time of the visit on 4/3/24. The Administrator agreed to advise LPA when two clients were relocated to new ARF's. The facility census as of today is four (4) clients.

The completed change of capacity request will be forwarded to management for final review and approval. Approval notification to licensee will be made by Community Care Licensing, and a new license will be mailed to the licensee after final approval.

This report was discussed with Sylvia Freeman. A copy of this report along with Appeal Rights was provided to Sylvia Freeman at the conclusion of the visit, and her signature on this form acknowledges receipt of these rights..