Facility Evaluation Report

Licensing Program Analyst (LPA) KaSandra Lopez conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Amalia Soratorio. This is a relocation application of which facility Rose Garden Manor 565800349 is relocating this location. The facility is vendored by Tri-Counties Regional Center and as a level three home. Component III was conducted during the inspection.

At 1:04 PM, a physical plant tour was conducted inside and out. The home is single story. The physical plant is consistent with the submitted facility sketch/floor plan. An approved fire clearance was granted for six ambulatory residents. The facility has four private resident bedrooms and one shared bedroom. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture. There is no staff room therefore, the facility will have awake night staff only. All rooms were free of odors. All window screens were clean and maintained in good repair.

There is one common restroom in the hallway and a shared restroom between bedrooms 3 and 4. The resident restrooms have a shower with non-skid materials. The toilet and shower have grab bars. The hot water temperature was tested in the shared restroom was found to be within the range of 105*F and 120*F.

Resident and staff records will be stored in a locked cabinet. Medications will be centrally stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Kitchen knives are stored in a locked drawer in the kitchen. There is supply of dishes, utensils, pots, pans and drink ware . The supply of nonperishable food is adequate. There are no pesticides or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in garage. Report continued LIC 809-C.