Facility Evaluation Report

Licensing Program Analyst (LPA) Angel Ascencio conducted a pre-licensing visit to the above facility. The LPA met with applicant, Joseph Johnson. This is a change in location. This is a level 2 Adult Residential Facility that is ventured through Tri-Counties Regional Center.

The facility is two stories. At 9:15 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for four (4) ambulatory residents only. The facility has four (4) private resident bedrooms. All resident rooms have no direct exits to the outside. The facility has fire sprinklers . All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. Room # Six (6) is a designated staff room. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the hallway. One (1) is designated as a staff bathroom. The resident bathrooms have a shower with non-skid materials. The toilet and shower have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F.

Resident and staff records are stored in a filing cabinet which is currently located in the Office Room # One (1). Medications are centrally stored in a locked closet by the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in the closet.