Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a pre-licensing inspection on 04/11/2023.

LPA met with applicant Marvin Caro, Applicant , who will be the Administrator once the facility is approved for licensure. The facility has a fire clearance approval from the American Canyon Fire Department for a total capacity of 4 ambulatory clients only. Facility will operate with 24 hour staffing and Licensee will ensure sufficient staffing at all times.

During today’s visit LPA observed the following items:

· Lockable separate cabinets for medications, toxins/cleaners, and knives.

· All exits were unobstructed, · 1 charged Fire Extinguisher

· 6 hardwired smoke detectors and 1 carbon monoxide detector, were tested and observed operational

· Complete first Aid kit, night-lights, and flashlights for emergency lighting

· Supply of linens (bedsheets), paper products, and hygiene supplies available

· Required furnishings in 4 of 4 bedrooms

The Component III Orientation was completed.

Pre-licensing is complete with no corrections needed.

LPA will submit the pre-licensing application report to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.