Facility Evaluation Report

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. LPA Lopez identified herself, was granted entry by caregiver Pablo Avitia. LPA discussed the purpose of the visit with caregiver's Avitia and Andre Tanner.

According to the facility’s license, there may be a maximum of four (4) clients all of whom may ambulatory in at any given time at the facility site. During today’s inspection, the facility’s current census is three (3) clients living at the facility. There were 3 clients present at the facility site during the inspection.

During today's visit, LPA briefly toured the facility, and observed and briefly spoke with clients in care. LPA, accompanied by caregiver Avitia, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. The facility had sufficient space and equipment to facilitate dining, visitation, meetings, and activities.

Due to time constraints, the annual inspection could not be completed, and a subsequent visit will be conducted at a later date.

There were no deficiencies observed or cited during today’s visit.

An exit interview was conducted with senior staff Sandra Campbell. LPA spoke with Celina Brown via telephone regarding the visit. A copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided to senior staff Campbell at the conclusion of the visit. The signature below confirms the documents were received.