Facility Evaluation Report

Licensing Program Analyst (LPA) David Roman conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to Program Administrator, Jennifer Melcher.

The facility fire clearance was granted on 03/20/2025 and reflects that the facility was approved for four (4) of which 2 maybe non-ambulatory residents with delayed egress and perimeter gate. During today’s visit, LPA, accompanied by the Program Administrator, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Bedrooms contained the required furnishings. Water temperature was in compliance of 105 degrees.

The facility has enough linens, hygiene supplies and dining supplies for future clients to use. The facility has a locked medication room in the center area for storage of medication, first aid kits, and physician orders for meds. Professional office room contains confidential client and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Per the Program Administrator, no firearms or ammunition are or will be stored at the facility. Smoke alarms and carbon monoxide detectors were tested at 10:30AM, emergency lighting, and facility telephone were all operational. Fire extinguishers and first aid kits were present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of California Code of Regulations and Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Applicant was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the Program Administrator, to whom a copy of this report and the Licensee/Appeal Rights were provided. Their signature acknowledges the receipt of the report and appeal rights.