Facility Evaluation Report

Licensing Program Analyst (LPA) Angel Ascencio and Kelly Dulek conducted a Pre-Licensing Inspection with Applicant Representative Patrick Zeimer and Program Director Nicole Lomeli. An Application to operate a Social Rehabilitation Facility (SRF) was received by Community Care Licensing (CCL) on 11/15/2021. A Fire Clearance was approved for a maximum capacity of sixteen(16) ambulatory residents on 10/15/2021.

The proposed physical plant is a single story facility located in a residential neighborhood of Santa Paula, CA. A tour of the physical plant was conducted and the following observed:

KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient non-perishable food to accommodate a maximum capacity of 16 Clients for (seven) 7 days. There was sufficient dining and cook ware to accommodate a maximum capacity of 16 Clients. Cleaning supplies were stored in locked under-sink cabinets and locked closet. Knives and other sharps will be stored in a locked cabinet. Water temperature was measured and was within range of 105 degree F to 120 degrees F at the time of visit. There were no visible immediate hazards observed.

BEDROOMS: There are eight (8) Bedrooms, all of which are designated for resident use. All bedrooms are furnished for double occupancy. All bedrooms were equipped and supplied with appropriate furniture, bedding and linens. There were no visible hazards or discrepancies observed.

BATHROOMS: There are three (3) Bathrooms, two (2) are for resident use and one (1) is for staff. The resident bathrooms are full bathrooms with overhead shower head, non-skid tile and shower bench. All bathrooms were supplied with appropriate paper and hygiene products. COVID-19 signs are required inside all bathrooms and were observed during the visit. Water temperatures were measured in all bathrooms and measured within the required range of 105 degrees F to 120 degrees F at the time of the visit. Continued on LIC-809-C