Facility Evaluation Report

Licensing Program Analyst (LPA) K.Kaur conducted a Pre-licensing Inspection on this date. LPA met with Licensee/Administrator Marycruz Leyva . A tour of the facility was conducted together. Inspection is for a Change of Ownership with 4 residents present.

The facility has 3 bedrooms designated for residents. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. Fire extinguisher was observed with a service date of 1/17/2022. Smoke detectors and carbon monoxide detector were tested and observed to be operational. The First Aid Kit was observed to have the required supplies. Medication will be kept locked in in a separate closet with locked cabinets. Knives, cleaning supplies and chemicals will be locked in the medication closet until a built-in locked cabinet or locks can be installed in the kitchen.

The tour started in the Kitchen and proceeded to living area and resident's bedrooms. Residents' bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting. Bathroom was properly equipped and has trash cans with a fitting lid. Hot water was tested and was 112.6 F in the bathroom. LPA observed clients Admission Agreements and Physician Reports. Outside toured and observed free of obstructions. Facility has adequate seating in the front yard under shaded area. Facility phone number will be (559) 535-5388. Staff records have a criminal record clearance and first aid.

Required postings were observed. Component III was also conducted and completed.

Exit interview was conducted, report was signed on site and a printed copy of the report was provided to the

Licensee. Pre-licensing requirements were met.