Pre-licensing visit·December 22, 2025

On 12/22/2025, at approximately 10:00 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an announced Pre-licensing visit. LPA met with Administrator, David Salvador. An application for a change of ownership was submitted to Community Care Licensing Division (CCLD) on 03/07/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The pending facility will have a Dementia Care Program. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, total of up to six (6) residents. The fire clearance was approved on 05/09/2025. There are currently four (4) residents. Structure: The facility is a single-story building with six (6) bedrooms and three (3) bathrooms. There is one (1) designated staff room only. Entrance: There is only one (1) entrance being utilized. Required postings such as: Personal Rights of Residents, Rights of Resident by Council, Family Council, Infection Control, Emergency and Disaster Plan, Facility Sketch, Theft and Loss Policy, House Rules, Non-discrimination Policy and See Something Say Something are posted throughout the common areas. Common areas: The living room and dining room are neat, clean and organized with sufficient seating for both residents and staff. Both rooms are properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-five (75) degrees. No firearms observed or will be maintained on the premises. There is a working telephone on the premises. Fireplace: LPA observed fireplace covered and inaccessible to residents. (Continue to LIC 809-C) Resident/Staff files: The Resident and Staff files were observed to be kept in a locked cabinet located near the kitchen and inaccessible to residents. First-aid kit observed as well. Kitchen: Sufficient supplies of nonperishable foods and perishable foods were observed. Sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. The knives/sharps were observed stored in a locked kitchen drawer and inaccessible to the residents. The kitchen appliances were observed to be working and in proper condition. Emergency: The fire extinguisher was observed to be located near the kitchen. Medications: The medications were observed to be kept in two (2) separate areas, kitchen cabinet and storage closet. The medication storages were observed to be equipped with a lock to ensure medications will not be accessible to residents. Bedrooms: The bedrooms are properly furnished with bed, nightstand, applicable lightening, and seating. Window coverings are in good repair, not broken or damaged. LPA observed signal systems in each bedroom windows, working and in proper condition. Bathroom: The bathrooms are in proper condition and observed to be equipped with sufficient personal hygiene for each resident. Towels and washcloths will not be shared. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Hallways: The hallways/passageways are lighted appropriately Extra linens/covers were observed to be kept in storage cabinet within the hallway’s passageway. The Garage: The garage can be accessed from inside the facility. LPA observed the garage to be kept locked. LPA observed the garage to be used for extra storage with an additional freezer with extra food for residents. Laundry: The laundry room was observed to be kept locked. LPA observed additional cleaning solutions/toxins properly stored within laundry room and inaccessible to residents. Dryer and washer observed to be in good repair. Staff Room: LPA observed designated staff room to be locked and inaccessible to residents. (Continue to LIC 809-C) Water Temperature: The water temperature was measured in the bathrooms at 117 Fahrenheit, within regulations. Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested at 11:00 am. Outside: The outside is clean, free of hazards, and properly furnished with sufficient seating. A shaded area for residents was observed as well. Pool: There is no body of water. Administration: The facility had submitted an Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. Administrator: The Component III Orientation RCFE was shown/reviewed with the Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report was provided to the Administrator.