Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an announced pre-licensing inspection, and met with licensee Iman Tootoonchi (IT).

Facility had applied for 6 capacity including one non-ambulatory room of two residents and 3 ambulatory rooms with 4 residents. During the inspection, LPA inspected and observed 2 resident single rooms, 1 shared restroom, and 2 resident shared rooms each with restroom inside. All the rooms and restrooms are all on the first floor. LPA toured the living room, dining room, kitchen, and garage. The medication cabinet was observed locked. The storage of knives, sharp objects and toxic cleaning products were observed locked. The two staff live-in bedrooms and one restroom on the second floor were inspected. All the linen closets and cloth closets were inspected.

The smoke detectors were inspected. All smoke detector were working fine. Fire extinguisher date is valid. Address Identification was placed and was clearly visible.

Front yard and back yard were inspected, and were observed free of obstruction. No bodies of water were observed in the backyard. The fence and gate were in good condition. The gate in the backyard was not locked. There were string attached to latch of the gate to be able to open the gate from outside of the gate for non-ambulatory access.

Component III orientation was conducted for IT. LPA answered the questions that IT asked. Exit interview was conducted. No deficiency was noted during today's inspection. This report was provided to IT to review and to sign. A copy of this report emailed to IT.