Facility Evaluation Report

This is a pre-licensing visit (Letter sent on 8/16/2024 was provided to licensee on 09/03/2024 as they report they had not received any mail from the department.

On 09/03/2024, Licensing Program Analyst (LPA) Kesha Lewis arrived announced to conduct a Pre-Licensing visit. LPA was greeted by licensee and explained the purpose of the visit. The purpose of this visit was to conduct a Pre-Licensing Visit.

This facility will be licensed to hold 4 residents, of which 4 may be ambulatory in bedrooms. This facility is also awaiting vendorization from Valley Mountain Regional Center and will accept and hold Level 4I residents.

A tour of the facility was conducted. Smoke detectors and carbon monoxide detectors were tested and are in good repair.

A tour of the kitchen area was toured. A review of food supply was conducted to ensure a 2 day perishable and 7 day non-perishable food supply was available. This facility will have a locked medication cabinet located in the kitchen. A first aid kit was observed and had all the required components. Fire extinguisher was located in kitchen and was serviced on 01/25/2024 by the local fire company, Coast Fire Equipment Co.

A tour of the family room was conducted. Furniture and furnishings were observed to be in good repair.

A tour of the backyard was conducted with no hazards present. Perimeter gate was observed to be in good repair.

A tour of garage was conducted. A washer and dryer was identified. Detergent, toxins and other cleaning supplies were observed to be locked and made inaccessible.

A tour of the resident bedrooms were conducted. Furniture and furnishing were observed to meet the residents needs.

A linen closet was located in hallway and was observed to have a sufficient amount of linen to meet the residents needs at this time.

A tour of two resident restrooms were toured. Hot water temperature was taken to ensure that it was in within 105-120 degrees. Comp III completed.