Facility Evaluation Report

On 04/12/22, Licensing Program Analyst (LPA) M. Medina conducted an announced Pre-licensing inspection. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensee Kari Gaither. LPA toured the facility with Licensee. The facility is 4 bedrooms and 2 bathrooms home. Fire clearance was granted for 4 ambulatory residents.

Common areas were furnished and had adequate seating and lighting available. Kitchen was toured and observed to have dishes, plate, and utensils. All bedrooms were observed to have required furnishings. LPA observed a 2 day supply of perishable foods and a 7 day supply of non-perishable foods. Knives were observed to be locked and secure in kitchen drawer. Medications will be kept in locked closet. Hot water temperature measured at 111 degrees F. First aid kit was observed and contained all required items. A fire extinguisher was observed and has a service date of 03/09/22.

Cleaning supplies and chemicals were observed to be in a locked cabinet in the laundry room and under kitchen sink. garage. Outside of facility toured. Exits were open and free of obstructions. Smoke detectors and carbon monoxide detectors were observed to be operational during this inspection.

Component III was conducted during today's pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.