Facility Evaluation Report

On 11/3/2022 Licensing Program Analyst (LPA) Dominic Tobola arrived to this facility for the purpose of completing a pre-licensing evaluation. LPA was greeted by Licensee/Administrator Applicants Sheila Alonzo and Jiovanni Alonzo and conducted a tour of the facility. The facility is a 4 bedroom, 2 bathroom, single story house. LPA toured the entire premise which was found to be clean and orderly. Fire extinguisher was recently purchased on 6/26/2022. Smoke detectors and monoxide detectors which were all tested and found to be in working order. Medications, facility files and emergency supplies are stored in a secured closet located in the living room area. Toxins and cleaning supplies are secured in locked cabinets in the kitchen the garage. Sharps and knives are also found to be secured in a locked cabinet in the kitchen.

LPA observed at least a minimum of a 2 day supply of perishable and 7 day supply of non-perishable food necessary for 3 clients. There are cabinets located in the client common space with additional linen supplies and hygiene products for clients upon request.

Beds were made with appropriate linens. Furniture is appeared safe and adequate. Hot water temperature was measured at 105.4 degrees F which is within regulation between 105 degrees F and 120 degrees F.

A fire clearance for this facility has been granted for 3 ambulatory clients, and 0 non-ambulatory clients and 0 bedridden clients. An emergency exit along the right side of the facility are unobstructed.

Component III orientation was conducted with the Licensee Applicants.

The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager.

This report was reviewed with applicant and a copy was provided to the Licensee.