Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa conducted a pre-licensing inspection on 01/23/2023. LPA met with Administrator/ Licensee April Walford and Rohan Walford, Licensee/Owner. The facility has a fire clearance approval from the Woodland Fire Department for 6 non-ambulatory residents. Facility will operate with 24-hour staffing and Licensee will ensure sufficient staffing at all times.

During today’s visit LPA observed the following items:

· Lockable separate cabinets for medications, toxins, and knives/sharps.

· Carbon monoxide detector tested and observed to be operational at the time of inspection.

· First Aid kit, night-lights, and flashlights for emergency lighting were observed.

· Supply of linens, paper products, and hygiene supplies available; and perishable and non-perishable food, as required in Title 22.

· Grab bars and non-slip mats in 2 of 2 bathrooms; and water temperature in bathrooms and kitchen was between 105-111 F.

· 1 Fire Extinguisher fully charged, purchased on 09/15/2022, mounted in kitchen/dining room area. Hard-wired Smoke Detector System inspected by Woodland Fire Department on 09/26/2022.

· Administrator Certification was current as of 10/22/2022 Certificate # 6064397740.

Component III Orientation was completed during today's inspection.

Covid-19 Mitigation Plan and Infection Control Plan Has been submitted to Application Unit Analyst.

Pre-Licensing is complete. LPA will submit the pre-licensing report to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.