Pre-licensing visit·December 18, 2025

Licensing Program Analyst (LPA) Angela Panushkina conducted a Pre-Licensing Inspection and met with the Applicant, Valiant Po. This is a Change of Ownership Application from facility #197610091 to #197610840 . An application to operate Residential Care Facility for the Elderly was received by Community Care Licensing (CCL) on 06/12/2025. A fire clearance was approved on 09/04/2025 for a maximum capacity of six (6) residents, of which five (5) Non-ambulatory and one (1) Bedridden (in bedroom #5) A tour of the physical plant was initiated at 12:40pm and the following were observed: The facility is a single-story home consisting of four (4) bedrooms, designated for residents’ use only, and two and a half (2 ½ ) bathrooms. Room #2 is designated for live-in staff use only. 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. Facility maintains a temperature of 70°F. LPA observed all bathrooms are clean and in good repair. All bathrooms have a working toilet, wash basin and a shower. Properly supplied with toilet paper, soap and paper towels. At 12:55pm, the hot water temperature measured at 116.7°F. All trash cans in bathrooms had fitted lids to protect them from cross contamination. The kitchen area is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable foods and dining wares to accommodate a maximum capacity of six (6). There is a fire extinguisher in the kitchen area and was last serviced on 08/11/2025. Continue on LIC809-C The medications are kept in a locked cabinet/drawer located by the kitchen area. Resident and staff files were observed in a locked metal cabinet located in the dining area. The first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of six residents. At 1:00pm, smoke and carbon monoxide detectors were tested and observed to be operable. There were no visible immediate hazards. The laundry room is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. At 1:10pm, LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The outdoor area was free of visible immediate hazards. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Smoke detectors and carbon monoxide were tested at 1:15pm and observed to be functional. Between 1:20pm to 2:20pm, LPA reviewed records of four (4) residents and two (2) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentarians. Component III was conducted at 2:30pm. Pursuant to Title 22, Division 6 Chapter 2, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised, and a copy of this report will be emailed. Exit interview conducted and copy of this report signed and delivered