Pre-licensing visit·November 6, 2025

Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing visit with the licensee. Identification of the Licensee was verified by photo ID. The facility has a capacity of six (6). Application received for five (5) non-ambulatory and one (1) bedridden in room # 4. Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The common areas (kitchen, living room, and dining/office areas) were appropriately furnished, and lighting was adequate. Cabinets stocked with canned and dried foods, with plenty of water in laundry area storage cabinets. The appliances in the kitchen appeared to be functional. The sharps are stored and locked in a drawer in kitchen and toxins locked under kitchen sink. The living room has a television and comfortable furniture. There is also a television in the dining room. Games and activities for residents are stored on the living room console table. There are two (2) wall mounted fire extinguishers in the home: One (1) in the kitchen/dining room and one (1) located near bedrooms #1 and #2. Both fire extinguishers observed to be fully charged. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at 12:15 pm. An emergency exit plan/sketch all over facility and in each bedroom and other posting requirements in the living room There are three (3) bathrooms in the facility. The hot water was tested for the bathrooms and all bathroom’s hot water at 105. °F. Bathrooms have trash cans with lids, hand soap and paper towels, and grab bars. There are five (5) resident bedrooms and one staff room. Extra linen stored in resident closets and staff room storage. Medications to be stored and locked in tall office cabinet and staff files to be store in small office cabinet. Toxins locked under the kitchen sink. The first aid kit on living room shelf. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all entry/exit doors. Facility appears to be clean and in good repair. Patio has screened gazebo with patio table and sufficient seating for residents to conduct outdoor activities. Laundry room at end of kitchen. The appliances observed to be in good repair. There is no body of water at the facility. Component III was conducted with the administrator and understanding of Title 22 confirmed by the administrator. This facility is ready to be licensed. Copy of this report will be forwarded to the CAB specialist. Exit interview conducted/Copy of report given.