Facility Evaluation Report
On April 17, 2025, at 10:00 a.m. Licensing Program Analysts (LPA’s) Sarah Benson arrived at the facility to conduct a pre-licensing inspection. LPA Benson met with Jeremy Potter Licensee and explained the purpose of the visit.
During today's inspection, LPA and Applicant conducted a tour of four residents room, three bathrooms, kitchen, and the common areas. Tiffany Battle is designated to be the Administrator, LPA observed Administrator Certificate #7029309740 to be active with expiration date of 10-29-26. LPA observed a designated lock area for files, medications, sharps and toxins. LPA observed a fire extinguisher present with service date of 1-3-25. LPA and Applicant discussed ensuring fire extinguishers are serviced annually. LPA observed auditory devices present on all exit doors, LPA observed the alerts to be working. The facility has not previously been licensed.
LPA observed facility to have preparation of seven days of nonperishable food present at the facility with a pantry of cereal, oatmeal, canned vegetables and grains. LPA observed facility having the presence of books and board games for activities. LPA observed the facility to have the required compliance posters posted in a conspicuous space. LPA observed the exterior of the facility to be free from obstruction in pathway. LPA observed First Aid kit to be recently purchased, filled with the requires items listed in 87465 Incidental Medical and Dental Care (a)(8)(A-F). LPA and Applicant discussed that facility is to have night lights maintained in hallways and passages to non private bathrooms. LPA observed nonskid mats presence in bathroom.
Inspection tool completed and facility is in compliance to Title 22. Comp III waived. Applicant has passed the Pre-Licensing component of the application process.
LPA will notify the Centralized Application Bureau of completion. Facility is not licensed until notify by Centralized Application Bureau Analyst along with a copy of license.
Exit interview conducted and copy of report was provided to administrator.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction