Facility Evaluation Report

On 08/25/2023 at 11:30am, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to the facility to conduct a Pre-Licensing visit. LPA Pascua met with Applicant, Iboni James. This facility will hold 4 residents who are deemed to be ambulatory only. This facility is awaiting vendorization from Valley Mountain Regional Center to serve and retain Level 4I residents.

Current Census was 0. A brief interview with Applicant was conducted.

The applicant has an administrator's certificate # 6066151735 and expires on 07/09/2025. First Aid and CPR was reviewed and is in compliance at this time.

LPA toured the living room which will be used for a facility game room for residents in care. Furniture and furnishings were observed to be in good repair.

The fire extinguisher, located in the kitchen area, was purchased on 07/26/2023 and had a receipt attached to it at this time. All smoke detectors and carbon monoxide were present and working at this time.

The office area was toured and was observed to have all the required posters at this time.

A tour of the garage was conducted. LPA observed a locked cabinet which would hold resident and staff records. In addition, the facility will be holding medication in a locked cabinet located in the garage. This cabinet also hold knives, scissors, and additional cleaning supplies. A washer and dryer was identified in the garage.

The kitchen area was toured. Facility freezer and refrigerator showed to be functional and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time.

LPA observed a hallway closet, where additional linen was located. This hallway closet that was locked will also store additional cleaning supplies, laundry detergent, and other supplies.