Facility Evaluation Report

Licensing Program Analyst (LPA) K.Kaur conducted a Pre-licensing Inspection on this date. LPA met with Licensee/Administrator Eesaeng Martinez . A tour of the facility was conducted together.

The facility has 2 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: 6/7/2022. 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 cabinets next to bathroom. Knives, cleaning supplies and chemicals will be locked in the garage until a built-in locked cabinet can be installed next to 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. Bathrooms were properly equipped and will have trash cans with a fitting lid. Hot water was tested and was 106 F in the bathroom. Pool was observed locked. Patio has a covered sitting area and a self-latching gate was observed in the backyard. 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.