Facility Evaluation Report

On 04/02/2025, Licensing Program Manager (LPM), Lisa Rios and Licensing Program Analysts (LPAs) Arielle Pascua and Triel Lindstrom arrived announced to conduct a Pre-Licensing Visit. LPAs met with Facility Staff Donald Stewart and Kenroy Anderson. LPA Pascua asked for staff to call the applicant to inform them that CCL was present. Applicant Iboni James arrived shortly after. LPA Pascua explained the purpose of the visit. The purpose of this Pre-Licensing Visit is due to a change of ownership.

Current census is 4. 2 out of 4 residents were out at this time. A brief interview with Applicant James was conducted.

The facility has a fire clearance for 4 ambulatory residents only. This facility will also awaiting vendorization from Valley Mountain Regional Center to accept and retain Level 4I residents at this time.

LPAs reviewed 4 resident files and 4 staff files. All files were current and up to date.

A tour of the kitchen was conducted. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care. A tour of the pantry was conducted where the facility holds extra non-perishable food supply.

LPA observed a locked centralized stored medication cabinet located in the living room. Along with the administrator, the LPA observed, reviewed, and compared resident medication and electronic medication dispensing logs. First Aid Kit was present and contained all of the required components. A fire extinguisher was located in the living room and was serviced and valid until 07/30/2025.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

A tour of the garage was conducted. Additional food supply was identified.