Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela conducted a pre-licensing inspection on 02/09/2022.

LPA met with applicant Rosie Skillman, who will be the Administrator once the facility is approved for licensure. Additionally Judy Johnson, administrator assistant was present. The facility received a fire clearance approval on 1/9/2022 from the Vallejo Fire Department for total capacity of 6 ambulatory clients. 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:

· COVID-19 postings and screening station

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

· 4 smoke detectors and 1 carbon monoxide detectors, which were tested and observed operational.

· Supply of linens, paper products, and hygiene supplies available

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

· Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster).

· The water temperature was tested during inspection an within the required 105 to 120 degrees F

The Component III Orientation was completed.

Pre-licensing is complete with no corrections needed. LPA will review file and process application for licensure.