Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to complete a Annual inspection. .

Currently there are no clients at the facility. Fire clearance was granted for 4 Non-ambulatory clients.

Facility was inspected. Outdoor exits are clear and accessible. There one floor to this facility. 4 resident bedrooms and 2 bathrooms.

Hot water temperature is within the required ranges. Smoke detectors and carbon monoxide detectors are operational. Fire extinguisher are fully charge.

The following forms and documents were requested to be submitted within 15 days:

(1) LIC308 Designation of Administrative Responsibility

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. An exit interview was conducted and a copy of this report was provided.