Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela conducted a pre-licensing inspection on 12/29/2021. LPA met with Applicant Ernesto Zamora and toured the inside and outside of the home. The facility received a fire clearance approval from the Vallejo Fire Department on 10/25/2021 for a total capacity of 3 ambulatory clients. Facility will operate from the top level of the home with a live-in staff; Licensee will ensure sufficient staffing at all times.

During today’s visit LPA observed the following items:

COVID-19 postings and screening station at entrance

Lockable separate cabinets for medications, toxins, and knives

4 smoke detectors & 1 carbon monoxide detector

First Aid kit, night-lights, and flashlights for emergency lighting

Supply of linens, paper products, and hygiene supplies available

Fire Extinguisher charged and will be serviced yearly

Required furnishings in both 2 client bedrooms

Administrator Certification for Jennifer Powell (EXP: 10/21/2022)

Required postings (Personal Rights, Emergency plan/numbers, Visitors Policy, CCL complaint)

Facility has submitted their Mitigation Plan (LIC808)

The Component III Orientation was completed during today's visit with applicant, Ernesto Zamora.

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