Pre-licensing visit·September 4, 2025

On 9/4/25 at 12:30pm, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Pre-Licensing Inspection with facility Administrator Singh Anmol. Upon arrival, LPA introduced herself by showing her department badge. This is a single-story house which will be operating as a Residential Care Facility for the Elderly (RCFE). A fire clearance was approved on July 17th, 2025, for five (5) Non-Ambulatory residents, and one (1) Bedridden resident for bedroom #4. Facility also applied for Hospice waiver for six (6) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected; they were tested and are operational. The facility has one (1) fire extinguisher that was purchased on 7/5/2025 and is located in the kitchen area. A tour of the physical plant was initiated at approximately 12:50pm and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, gas stove, microwave oven and sink. LPA observed adequate supplies of emergency and nonperishable food properly stored inside the kitchen pantry. Perishable food items are not required at this time as there are no residents in the facility. Licensee will supply sufficient amount of perishable food upon arrival of the residents. Complete dining ware was available to accommodate a maximum capacity of six (6) residents. Knives and other sharps were observed locked inside separate closet located next to the refrigerator. Chemicals observed to be stored inside a locked cabinet under the kitchen sink. BEDROOMS: The facility has four (4) bedrooms, all bedrooms are designated for residents' use only. All residents' bedrooms were observed to be nicely furnished with beds, night stands, lamps, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. An additional linen is available inside the closet located in the hallway. Continue on LIC809-C BATHROOMS: The facility has two (2) bathrooms, both bathrooms are designated for residents’ and staff use. Bathrooms were observed to have the proper fixtures, grab bars, non-skid mats, trash cans with closed lids, paper towels and washing hands signs. The hot water delivered in the bathrooms measured at 1:15pm to be at 110.7 degrees F. COMMON AREAS: These include living room and a dining room. The living room was equipped with new furniture, a television, and coffee table. The dining area has a dining table to accommodate six (6) residents. There were no visible immediate hazards. The facility has a comfortable temperature which was measured at 1:10pm to be at 73 degrees F. LPA observed various activity supplies nicely placed on the coffee table and ready for residents' use. LAUNDRY ROOM: The washer and dryer were placed in the garage. Laundry chemicals will also be stored inside the garage in a separate storage, which will always be locked and under supervision. The garage door observed to be locked and not accessible. MEDICATIONS/ Client/Staff Files: Medications will be kept inside the locked cabinets located in the hallway adjacent to bathroom #1. First Aid and the new manual are also locked inside the same cabinet. LPA observed the First-aid has all proper items and is current. Staff and residents’ files will also be kept inside the same locked cabinets. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. The backyard of the facility is properly fenced, has a patio and backyard furniture to accommodate six (6) residents. GARAGE: The garage is currently being used as storage for facility equipment. The Garage is attached to the facility; and has access from the house. The Laundry machined are also places inside the garage. Continue on LIC809-C LPA observed the facility is clean, safe and sanitary. All window screens were in good repair. Auditory signals were installed on all exit doors. All passageways were free of obstruction. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised. An emergency exit plan/sketch along with other posting requirements were available and posted on the wall. No deficiency cited on today’s visit. Exit interview conducted and a copy of this report signed and delivered to the Administrator.