Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena conducted a pre-licensing visit to the above noted facility. The LPA met with Administrator, Laila Kulungu. This is an application for a Change of Ownership (CHOW). The facility applied for five (5) non-ambulatory residents, and one (1) bedridden resident.

At 10:40 a.m., the LPA and the facility designee conducted a physical plant tour inside and out to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The facility is a one story dwelling. An approved fire clearance was received on 10/23/2023, clearing them for five (5) non-ambulatory residents; one (1) bedridden resident in bedroom #2.

KITCHEN: Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans, and drink ware is adequate. The temperatures for the refrigerator and freezer could not be verified as neither have a thermometer. The supply of nonperishable food is adequate. There are no pesticides (poisons) 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, and house cleaning supplies are stored and locked under the sink cabinet area. No flies or other vermin were observed. Water temperature was recorded at 112.3 degrees Fahrenheit.

BEDROOMS: The facility has six (6) private residents’ bedrooms, and one (1) staff’s bedroom, total of seven(7) bedrooms. Bedroom # 2 has been approved and cleared for one bedridden resident. All bedrooms were set up with night stands, lamps, and closet space. The screen sliding door in bedroom#2 became jammed when trying to slide it open.