Facility Evaluation Report

Announced Prelicensing visit made out to this facility by LPA Charlie Yang on 02/07/2022. This LPA was met by the Applicant, Kuljit Kaur, who was briefly interviewed prior to the facility walk through.

This Applicant is seeking licensure for a 6-bed Adult Residential Facility to accept and retain ambulatory only residents at this time. It was also learned that this Applicant is in the process of vendorization through Valley Mountain Regional Center for a level 4I care home.

This LPA was present to follow up on the previous Prelicensing visit conducted on 02/07/2022 to make sure the following items were brought into compliance:

Turn down the hot water heater so that the hot water being dispensed is within the range of 105-120 degrees since it was measured at 134.4 degrees

Update and maintain personnel record(s) on site available for review by CCL

Update and maintain resident record(s) on site available for review by CCL

Maintain proof of annual purchase or maintenance of all facility fire extinguishers

Update the LIC 999 to properly reflect all rooms and areas in this facility intended for resident use, staff use, and storage purposes

Based on today's Prelicensing visit this facility has been found to be in compliance at this time.

Component III conducted and completed with facility Applicant at this time.