Facility Evaluation Report

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

Currently there are no clients at the facility. Facility was inspected both indoors and outdoors. LPA inspected proposed bedrooms, bathrooms, kitchen, garage, and common areas. Outdoor exits are clear and accessible. There are two floors to this facility. 5 resident bedrooms, and 3 bathrooms were observed. There is a jacuzzi in the backyard with a locked cover. The jacuzzi has been drained and it not in use.

Hot water temperature was measured at 115 degrees. Smoke detectors and carbon monoxide detectors were checked and operational. Fire extinguisher indicator revealed a full charge. Kitchen is clean sanitary, and in good repair. There is a locked areas for cleaning supplies, sharps, medications and toxins.

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