Facility Evaluation Report

Licensing Program Analysts (LPA) Kesha Lewis and Albert Johnson contacted the facility to commence an announced Pre-Licensing visit on 12/01/2022 at 10:00am to ensure compliance with Title 22 regulations.

LPA'S was allowed entry into the facility that will be licensed for a capacity of 5 non-ambulatory residents and 1 bedridden resident. LPA'S met with, Vargas, Bernadette licensee and administrator who assisted with today’s visit. Administrator certificate number #6061708740 expires 10/22/2024.

LPA toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed there are no residents at this time.

LPA observed the kitchen area, dining area, bedrooms, bathrooms, storage areas, garage, and laundry room. LPA observed knives/sharps, medications, and records storage to be locked. LPA observed required furniture, and lighting throughout the facility.

Pre licensing Inspection and Component Three completion and verification email sent to CAB on 12/02/2022.

Exit Interview conducted and a copy of the report was left at facility .