Pre-licensing visit·December 18, 2025

At 9:45 AM, Licensing Program Analyst (LPA), Huma Rahimi conducted an announced Pre-Licensing visit to the above facility and met with Armine Marie Jimenez, Administrator/Licensee, and explained the reason for the visit. At the time of this visit LPA did not observe any residents present in the facility. Fire Clearance dated 09/22/2025 and received for five (5) Non-ambulatory residents and one (1) bedridden in room #2. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under 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: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, oven, and a sink. Stove was observed in a good working condition. At 9:50 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. LPA also observed that additional knives will be kept locked under the kitchen sink. A Fire Extinguisher was observed and last purchased on 09/02/2025. It was observed handing on the wall by the main entrance. MEDICATION ROOM: The centrally stored medication will be kept in the in the locked cabinet in the laundry area. Facility staff and residents files will be kept locked in the same cabinet. BEDROOMS: There are three (3) bedrooms designated for residents use. All three (3) bedrooms are share. LPA observed that all bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. The facility will have an awake staff. Continue on LIC 809C BATHROOMS: There are two (2) bathrooms at the facility. One of the bathrooms is attached with bedroom #1. L PA observed all bathrooms are clean and in a good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 120.0°. LAUNDRY ROOM: The laundry room is located next to the kitchen. The laundry area has two hanging cabinets with locks and all laundry detergents and other cleaning supplies will be kept locked and inaccessible to residents in care. The washer/dryer appear to be in good working condition. COMMON AREAS: The facility maintains a comfortable temperature at 68°F. The living room and dining area appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility. SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA observed appropriate outdoor furniture in the backyard that can accommodate up to six (6) residents. A separate kitchen area is also located in the backyard. LPA observed two exits at the rear of the facility; however, these exits will not be used by residents in care. The facility is attached to an Adult Residential Facility (ARF), Goddess Touch Assisted Living, license number 197610835, and both rear exits are designated for use by the ARF. LPA observed two additional exits located at the front of the facility, which will serve as the primary exits for residents in care. There is no swimming pool or other bodies of water on the premises. All exits were observed to be free of obstruction and hazards. Garage/Storage: The facility does not have a garage; however, one (1) extra locked storage was observed in the which the facility will keep extra supplies of the facility. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were connected together and located throughout the facility. At 10:20 AM, they were tested and observed to be operational. Component III was conducted with the Licensee/Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and with a copy of this report was provided to the Applicant/Licensee