Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Dolores arrived announced to conduct the facility's pre-licensing inspection. LPA met with Licensees Anthony Tran and Thuy Tran.

There are no clients in care. LPA toured the facility to include 4 bedrooms, 2 bathrooms, living room, kitchen, and backyard. Fire exit routes are free and clear of obstruction. Fire clearance is approved for 4 ambulatory residents.

Facility has a designated entry point to include symptom screening and temperature check. Bedrooms observed supplied with furniture to include a bed, dresser, night stands, lights, and linens. LPA observed additional clean linens and towels. Facility has kitchen supplies to include eating utensils, plates, bowls, and cooking supplies. Medication cabinet observed to be locked. Trash cans observed with lid. First aid kit supplied with tweezers, scissors, bandages, and gauze. Hot water water temperature maintained at 113.7 degrees Fahrenheit. Facility has at least a 7 days worth of non-perishables. LPA observed facility's carbon monoxide detector. The following posters observed to include personal rights and grievance policy.

Component III is being waived because applicant has been a facility administrator since February 2020.

No issues noted during this pre-licensing inspection.

LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

This report was reviewed with Licensees, Anthony Tran and Thuy Tran and a copy of this report provided.