An application was submitted to Community Care Licensing Department (CCLD) and received on 12/3/2020 for a change of location to serve individuals for ages 60 and older. The requested capacity is for six (6) residents. Structure: The facility consists of 4 resident bedrooms, 3 bathrooms, dining area, kitchen, living room, laundry area, storage room and a patio area in the backyard. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Two bedrooms have an exit door that leads to the backyard. Bathrooms were checked. Toilets and water faucets worked properly, shower was free of mold/mildew, water temperature measured at 112.6 degrees F in resident bathroom. Bathrooms have grab bars and non-skid mats. Common areas were clean and clear of hazards; doorways were free of obstructions. Linens & Hygiene Supplies: Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Beds have the required linen/supplies which include, pillowcase, fitted sheet, blanket and bedspreads. Ample supply of linen is stored at the facility. Emergency Phone Numbers, Exit Plan, & Menu: Emergency numbers are posted and readily available for review in the living room. Facility has one land line telephone located in the living room and another in the kitchen. There are 3 fire extinguishers located in the living room, dining area and hallway. Food Service: Dishes, cups, and flatware are stored in the facility’s kitchen. Ample food supply is stored in the kitchen and consists of the following: 7-day non-perishables. Smoke Detectors/Carbon Monoxide(s): Facility has interconnected 2 in 1 smoke detectors/carbon monoxide detectors. Appliances: Stove burners, gas oven, microwave, and washer/dryer are in working condition. Toxins: Cleaning supplies, and toxins are stored in the cabinet inside the garage. Medication, First-Aid Kit & Book: Designated centrally stored medication will be stored inside of a locked cabinet in the kitchen. First-aid kit has sufficient bandages, one (1) tweezer, one (1) thermometer, one (1) First Aid Manual, and one (1) pair of scissors.

Component III:

When the applicant was asked if he had a general understanding of Title 22 he responded in the affirmative.

A telephonic exit interview was conducted with Applicant Rustico Punzalan, and a hard copy was provided via email for signature.

Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.