Pre-licensing visit·June 5, 2025

Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM), Nichelle Gillyard conducted a Pre-Licensing Inspection and met with the Administrator/Applicant, David Monroy. This is a Change of Ownership Application from facility "BROOKDALE CHATSWORTH" to CHATSWORTH COMMONS SENIOR LIVING, LLC . An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 05/07/2025. A Fire Clearance was approved on 09/05/2025 for a total capacity of 268, of which 134 Ambulatory, 124 Non-ambulatory and 10 can be Bedridden in rooms #107,111,119,121,123,127,161,163, 165 & 167. Facility is a two (2) story building. However, the rooms on a second level are numbered from 200-400. There is no 3 rd or 4 th level. In the main entrance of the building there is a cafe that is a self-serving refreshment and snack area with seating. The main living room has seating and a grand piano for entertainment. Today's site visit consisted of LPA/LPM touring the physical plant inside and outside and observed the following: KITCHEN: The main kitchen that prepares all the meals for the facility is located on the first floor. The kitchen is fully stocked with perishable and nonperishable foods. The kitchen work area surface appeared clean, and no food items are stocked with cleaning supplies. Food is restocked regularly at least 2 times a week. The residents with special dietary needs are posted in the kitchen prep area with pictures of the resident and their food choices or required preparation. Sharp knives/objects observed to be locked and inaccessible to residents in care. Continue on LIC809-C BEDROOMS: There are 173 bedrooms designated for residents’ use. LPA/LPM observed the facility's model room in addition during the tour LPA/LPM observed unoccupied, empty rooms and rooms occupying residents. The bedrooms have sufficient closet space. Resident room was observed to be clean and sanitary. COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of 268 residents. These included a living room furniture, a television, tables and chairs and a dining area. There is a functioning telephone on the premises. LPA/LPM observed license to be posted in a conspicuous area along with the complaint poster and personal rights, including other required postings. Smoke and carbon monoxide detectors were located throughout the facility, and at 11:30am they were tested and observed to be operational. LPA/LPM also observed fire extinguishers located throughout and outside of the facility, and they were last serviced on 03/06/2025. A fire inspection is conducted every year on the operation of the sprinkler system, electrical panels, water heaters, fire extinguishers, manual pull alarms, carbon monoxide detector and smoke detector. Copy of the inspection report was given to LPA. LAUNDRY ROOM: The laundry room is located downstairs and upstairs. The washers/dryers appear to be in good condition. Laundry supplies are kept locked and inaccessible to residents in care MEDICATION ROOM: The Med-room is located on a 1 st floor by the room #159. The facility also has four (4) MedCarts that were observed to be locked and inaccessible to residents. SURROUNDING GROUNDS: The driveway serves as a large parking lot for guests for drop-off purpose only. The back of the facility has sufficient yard space. LPA/LPM observed appropriate outdoor furniture, with a covered shaded area for the residents. No bodies of water. Component III was conducted at 1:00pm. LPA/LPM discussed the following which include but is not limited to Component III; care and supervision, reporting requirements, preplacement, criminal record, food service, medications and maintaining physical plant and resident/staff records. LPA/LPM clarified if the facility will be admitting or advertising Dementia Care. LPA/LPM were informed that there is no current plan. The status is: To-be-determined. OTHER: L PA/LPM Reviewed Certificate of Occupancy and it is clear that 1st floor is for Non-Ambulatory and 2nd floor Ambulatory residents only. Continue on LIC809-C The applicant will be given 10-days to submit the following before the facility can be licensed: · LIC610E with the name and licence number indicated from this report: CHATSWORTH COMMONS SENIOR LIVING, LLC (#197610638) · Infection Control Plan with the name and licence number indicated from this report: CHATSWORTH COMMONS SENIOR LIVING, LLC (#197610638) · Floor Plan with the name and licence number indicated from this report: CHATSWORTH COMMONS SENIOR LIVING, LLC (#197610638) Exit interview conducted and copy of this report signed and delivered.