Pre-licensing visit·January 5, 2026

On 01/05/2026, at 09:40 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an announced Pre-licensing visit. LPA met with Administrator, Bryna Ocampo. The facility’s designee, Raquel D Ambrosio was present for today’s visit as well. An application for a change of ownership was submitted to Community Care Licensing Division (CCLD) on 04/24/2025, 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 08/29/2025. There are currently four (4) residents. Structure: The facility is a single-story building with five (5) 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 but not limited to: Personal Rights of Residents, Rights of Resident by Council, Family Council, Infection Control, Emergency/Disaster Plan and Facility Sketch are posted throughout the common areas. Common areas: The living rooms 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 LIC809-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 to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Kitchen: Sufficient supplies of seven (7) day nonperishable foods and two (2) day 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 cabinet (adjacent to the medication cabinet) and inaccessible to the residents. The cleaning solutions/toxins were observed to be kept in a locked cabinet located underneath the kitchen sink. The kitchen appliances were observed to be working and in proper condition. LPA observed an additional refrigerator/freezer with additional food for residents. Emergency: The fire extinguisher was observed to be located near the kitchen and dated 9/11/2025. Medications: The medications were observed to be kept in a locked kitchen cabinet (adjacent to the locked knives/sharps cabinet). The medication storage was 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 throughout the facility to be 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. Appropriate grab-rails and slip-resistant mats observed and 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. 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. (Continue to LIC 809-C) Staff Room: LPA observed designated staff room to be locked and inaccessible to residents. Water Temperature: The hot water temperature was measured within regulations at 115.7 °F. LIC809C-continued Smoke detectors: Dual interconnected smoke detectors observed to be working properly and were tested at 10:30 am. Carbon monoxide observed to be working. 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. LPA observed an empty hot tub to be located outside. LPA observed it to be covered appropriately and non-operational (empty). 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. There were no immediate health and safety hazards observed during the day of inspection. Exit interview conducted and copy of this report issued to the Administrator.