Pre-licensing visit·July 3, 2025

Licensing Program Analyst (LPA) Nadia Shahbazian conducted a pre-licensing visit and inspection of the facility. LPA met with Gwen Sarabosing-Licensee/Administrator at 9:30am. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on November 5, 2024. A fire clearance was granted for five (5) non-ambulatory and one (1) bedridden residents for a total capacity of six (6). At approximately 10:30am, with the assistance of administrator, LPA took a tour of the physical plant and observed the following: Required postings were observed in the receiving area and the kitchen. Facility has four new fire extinguishers that were purchased on November 05, 2024; fire extinguishers are located in receiving area, dining room, kitchen and office. Facility is equipped with four fire doors, in the hallway, in living room and bedrooms #3 and #4. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected. At approximately 10:45am, smoke alarms/carbon monoxide detectors were tested and were observed to be functional. During the smoke/carbon monoxide test, LPA observed the fire doors properly closed automatically. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. All entry and exit doors have a functional auditory alert alarm when the doors open. The backyard of the facility has a covered patio large enough to hold outdoor activities. There was adequate backyard furniture. There is no swimming pool or body of water. There are two locked sheds, used to store supplies and furniture. The main entrance door and the dining room sliding door will be used for emergency exit use. There are two side gates leading to the front. There are exits in dining room, bedrooms #3, #4 and #5, all leading to the backyard. All exits were observed to be free of obstruction and were designated with exit signs atop each door. (continued in 809-C) Kitchen: The kitchen is equipped with a refrigerator, microwave, stove/oven and dishwasher. The appliances and fixtures were all functional. There is sufficient amount of dishes in kitchen cupboards. Even though facility does not have any residents, LPA observed enough perishable food supplies for 3 days and non-perishable food for 7 days. Knives and sharp objects were properly stored in a locked drawer in the kitchen and chemicals were locked underneath the kitchen sink cabinet. Medications will be locked in the kitchen cabinet; the first aid kit and the manual will also be kept in the kitchen. COMMON AREAS: The entrance door opens to the receiving area, which has a covered fireplace; no fireplace tools are present. Resident files will be kept in the locked cabinet in the receiving area. The dining and living rooms are located next to the kitchen. The dining area has a large table to accommodate six (6) residents. The living room has a television set and ample sitting, which will be used for activities and game area. Facility is equipped with internet access and land line telephone. There are three storages, one near the entrance door and two in the hallway. BEDROOMS: There are five (5) bedrooms designated for client use. Each bedroom is furnished with beds, night stands, chairs, closets, chest drawers, tight-fitting, lidded trash cans, bedding and linens. Bedroom #3 is a shared room and is designated as the bedridden resident room. BATHROOMS: The facility has three (3) full bathrooms. There is a bathroom across bedroom #1. Bedroom #3 has a full bathroom; bedrooms #4 and #5 have a shared full bathroom. All bathrooms were observed to have the proper fixtures, grab bars and anti-slip flooring. Hot water delivered in the bathrooms measured between 118-118.4 degrees Fahrenheit. OFFICE SPACE/CARE GIVER ROOM: Facility's garage is located at the front and was converted to a one bedroom unit for the staff use. The conversion was permitted as staff/care giver room; the unit has it's own bedroom, bathroom and kitchen. Office workstation consists of a desk and locked filing cabinets, in order to store confidential staff records. The office/care giver room may be used for living-in staff purposes but administrator will ensure to have an awake staff at all times, at the facility. Laundry machine and chemicals are locked in the staff room, inaccessible to residents. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.