Facility Evaluation Report

Licensing Program Analyst (LPA) Sara Martinez conducted an announced visit to complete the Pre-licensing inspection. LPA met with Licensee, Lupo Leyva and Bernadette Balungcas for an Adult Residential Facility with a capacity of four (4) residents.

The facility is a six (6) bedroom, four (4) bath home. There are four (4) client bedrooms, two (2) staff rooms, kitchen/dining area, one (1) living room area, a laundry room, and backyard. LPA toured the interior and exterior areas of the facility. The following were inspected:

Client Bedrooms : All bedrooms have the required bedding and furniture, such as, clean mattresses/linen, nightstands, dressers, chairs, lighting, and emergency lighting.

Client Bathrooms : The bathroom appliances were operating in safe and sanitary condition. The bathrooms have non-slip mats.

Kitchen and Dining Areas : Utensils and dishware are in good repair and ready for client use. Kitchen appliances and counter top were free of debris and in good repair. The knives and sharp objects were locked in the drawers. The water temperature was measured by LPA, the thermometer read at 115 degrees F.

Common Sitting Areas : There is adequate seating in the common areas. The facility has a a schedule for activities for the clients posted and a adequate amount of activities at the facility. The common seating area has a storage locker that will hold client files, staff files, and medication.