Facility Evaluation Report

Licensing Program Analyst (LPA) Dawn Segura conducted an announced Pre-Licensing visit. LPA was met by Applicants, Alex Rodriguez and Jackeline Gilbo, and granted entry into the facility. The purpose of today’s visit was to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on January 13, 2022, and the facility was approved for 6 ambulatory clients.

During today's visit, LPA, accompanied by applicants, toured the facility inside and outside and inspected every room. The facility was found to be in good repair with no pathway obstructions. Clients' bedrooms were observed to be clean and contained required furnishings. Toilets were found to be in working order. Facility temperature was 74 degrees F during the visit. Hot water temperature in client bathrooms measured at 117 and 115 degrees F. Hazardous and/or toxic chemicals were stored and secured in locked cabinets that are inaccessible to clients. There were locked closets for storage of medications and client and staff records. There was a first aid kit present in the facility. Activities and sufficient space in which to conduct activities were present. Fire extinguishers were observed in the facility. Hard-wired smoke and carbon monoxide detectors were present and were recently inspected by the local fire authority. No pools or bodies of water were observed near or on the premises. According to the applicants, no firearms and/or ammunition were present or will be stored in the facility. Non-perishable food items were present and appropriately stored in the facility. LPA conducted Component III with the applicants. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance.

Pre-Licensing is complete, and no deficiencies were observed during the visit. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted, and a copy of this report was provided to applicants, via email, following the visit.