Facility Evaluation Report

Licensing Program Analysts (LPAs) Tricia Danielson and Chinwe Nwogene conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. LPAs met with Licensee Liza Valencia. An initial application to operate an Adult Residential Facility (ARF) was received by the Central Applications Bureau (CAB) on 11/15/2021 for a total capacity of six (6) non-ambulatory and one (1) bedridden residents. Fire Clearance was granted for six (6) non-ambulatory and one (1) bedridden residents on 3/1/2022. LPAs observed the following:

Facility was a one story house with four (4) resident bedrooms, one (1) bathrooms, family room, dining area and kitchen.

Central heating and air conditioning system installed with a central panel located in the hallway to control entire house.

Each client bedroom will accommodate any non-ambulatory client. Bedroom #1 will accommodate a bedridden resident. Bedrooms #3 and #4 were furnished with bed, chair, closet, adequate lighting, and an operable smoke alarm/carbon monoxide detector. Bedroom #1 was missing a bed and night stand. Bedroom #2 was missing another bed, and clothing storage/dresser for both clients.

The bathrooms had a working toilet, wash basin, and shower. At 1:45 AM, LPAs began testing water temperatures in the client bathroom. LPAs verified water temperature was measured at 91 degrees Fahrenheit.

An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies were secured in a locked cabinet below the sink. Knives/sharp instruments will be stored in a locked cabinet. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition