Facility Evaluation Report

Licensing Program Analyst (LPA) Olson conducted an announced pre-licensing visit. LPA was accompanied by Tracy Jackson, Quality Assurance Specialist (QAS) for Tri-Counties Regional Center (via Facetime). LPA and QAS met with Administrator/Licensee Sylivia Rae Solorio. This is a new facility. Component III was conducted in conjunction with this pre-licensing visit.

The facility is a one story. A physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for 4 clients, 2 non-ambulatory residents.

Applicant/Administrator took LPA on a plant tour of the inside and outside of the one story facility and the following is noted:

Medications: There is a locked cupboard in the Kitchen for the medication.

Physical Plant: The facility is a 4 bedroom, 2 bathroom home with a kitchen, dining room/living room, and laundry room. Facility is clean, sanitary and in good repair. Indoor areas, outdoor porch, and backyard are free of obstructions. The facility does not have any pools or bodies of water. The facility does not store or allow firearms or ammunition to be stored at the facility. Any dangerous products/tools will be stored in locked shed, locked cupboards in the laundry room, kitchen, or storage area. All windows screens are clean and in good repair. Facility temperature is between 68-85 degrees. There is no fireplace. Smoke and carbon monoxide detectors are hard wired and were tested and operating properly throughout the facility.

Bedrooms: The facility has one staff bedroom and three resident bedrooms and two bathrooms for single and double occupancy. Rooms 1 and 2 are single occupancy, Room 3 is double occupancy. Bedrooms have beds for each resident with mattress, mattress pads, box springs and pillows which are clean and in good repair. Mattresses and pillows are flame-retardant. The rooms have dressers and plenty of closet space for residents. The rooms are furnished with chairs and proper lighting with lamps are in each room for clients.