Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela conducted a pre-licensing inspection on 3/11/2022. This is a single story home, with 4 bedrooms that will be used for clients, 2 bathrooms, living room, dining room, kitchen, two hallway closets and garage.

LPA met with applicant Armelle Gby who will be the Administrator once the facility is approved for licensure. The facility received a fire clearance approval from the Vallejo Fire Department on 1/19/2022 for a total of 5 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:

· Lockable metal cabinet for medication and client files.

· Toxins/cleaners are stored in the locked garage and knives are inaccessible in a high cabinet or will be locked in a drawer.

· 5 smoke detectors combination smoke & carbon monoxide detector, which were tested and observed operational and fire pull alarm.

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

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

· Fire Extinguisher charged and serviced 11/25/2021

· Required furnishings in all 4 bedrooms that include, bed, night stand, lamp, chair, dresser and required linens.

· Administrator Certifications; Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, and visitor policy).

· The water temperature was tested during inspection and was within regulation of 105-120 Degrees F.

The Component III Orientation was completed with applicant Armelle Gby.

LPA will submit the pre-licensing report to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. "Pre-licensing is complete and this facility has no deficiencies"