Pre-licensing visit·May 2, 2025

At 9:40a.m., Licensing Program Analyst (LPA), Antonia Alvizar-Ettima conducted an announced Pre-Licensing visit to the above facility and met with Administrator. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL). Fire Clearance was approved on 12/04/2024 for a maximum capacity of six (6) non-ambulatory residents, hospice waiver for two (2) residents age range 60 and over. The purpose of today’s visit is to inspect the facility to ensure that the physical plant is in compliance with rules and regulations of California Code of Regulations, Title 22, Division 6, Chapter 8. The facility is a single-story building in a residential community. The facility has two (2) fully charged fire extinguishers, locate in the entryway and laundry room. Fire extinguishers receipt dated May 02, 2025. A tour of the physical plant inside and outside was initiated at approximately 10:10a.m., and the following was observed: KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, dish washer, sink, stove and microwave. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked in a drawer in the kitchen and inaccessible to residents. LAUNDRY ROOM: The laundry room is located adjacent to the kitchen. The washer/dryer are new. Laundry supplies are kept inaccessible when not in use in a locked cabinet. BEDROOMS: There are four (4) bedrooms designated for residents to use. Bedroom #1-#2 are shared rooms, bedrooms #3-#4 are private rooms. All resident bedrooms are furnished with bed, chair, nightstand, dresser and required bedding and linen. Continue on LIC809-C Cont. from LIC 809 The bedrooms have sufficient closet space and have sufficient lighting. BATHROOMS: LPA inspected the bathrooms they are clean and in excellent condition. LPA observed three (3) bathrooms with grab bar and non-skid mats for residents and staff to use. Water temperature was within regulation ranging between 110.9°F – 116.1°F. LPA also observed sufficient quantity of toilet papers, soap and paper towels. COMMON AREAS: The facility maintains a comfortable temperature at 74°F. The living room has a television, recliner, couches, books, board games and magazines. The dining area has a table with six (6) chairs that were clean and properly furnished. MEDICATION: The medication and first aid kit will be kept in kitchen cabinet. All medication will be locked inaccessible to residents. The facility staff/resident files will be kept in a locked kitchen cabinet, inaccessible to residents. SMOKE DETECTORS/CARBON MONOXIDE: Four (4) smoke detectors were located in the bedrooms and throughout the facility. All smoke deters were dual carbon monoxide. They were tested and observed to be operational. SURROUNDING GROUNDS: The facility grounds were well landscaped and enclosed. The passageways and entrance to the facility were clear of obstruction. Entry and exit doors have a functional auditory alert when the doors open. There is an approved Accessory Dwelling Unit (ADU) on the left side of the facility. LPA observed appropriate outdoor furniture and sufficient yard for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. The facility has no bodies of water. Component III: Administrator, Amber Hewitt completed the Component III during today’s Pre-Licensing visit. Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and the applicant will be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and a copy of this report was provided to Administrator.