Pre-licensing visit·December 2, 2025

Licensing Program Analyst (LPA) Evelin Rios conducted a Pre-Licensing Inspection with the applicant representative/administrator, Glennard Tiu. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 07/11/2025. This is a change in ownership (CHOW) application. The current census for active license is six (6). A fire clearance was approved on 09/03/2025 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6). At entrance LPA observed required postings by the front door and a sign in sheet for visitors. A tour of the physical plant was initiated at approximately 9:25 a.m., and the following was observed: Bedrooms: There are six (06) total private bedrooms designated for residents use. Per STD 850, rooms #2 is cleared for one (01) bedridden resident. Bedrooms designated for resident use have appropriate furniture with sufficient lighting and storage space. LPA observed functional auditory alarms on all exit doors. LPA observed a fully charged fire extinguisher last serviced on 06/20/2025 by bedroom #4. Kitchen: The kitchen is equipped with a refrigerator, stove, oven, dishwasher and microwave. The facility has a sufficient amount of two day perishable and seven day non perishable supply of food. The facility has dishware and cook ware for the capacity of the facility. Knives are kept locked in a kitchen drawer. Cleaning supplies are kept locked under the kitchen sink. (Continue to LIC809-C) Common Areas: Furniture such as the dining table, chairs and couches were observed in good repair. Both living room and dining room have sufficient space and lighting. LPA observed a television and games in the living room. A fireplace was also observed not in use, secured with a screen. No tripping hazards observed. LPA observed a fully charged fire extinguisher last serviced on 06/20/2025 by the dining table. Bathrooms: The facility has three (03) bathrooms. Two (02) bathrooms are designated for resident use of which one (01) is located in a resident bedroom for private use. Bathrooms were observed to have proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured and was within regulation. Laundry/Garage: The laundry room is accessible to residents and equipped with a washer and dryer. LPA observed detergent, and cleaning supplies are kept locked in a laundry room closet. Entrance to the attached garage is through the laundry room. In the garage LPA observed a freezer and facility supplies. Resident/Staff Records: Residents' medication was observed locked in a kitchen cabinet. Resident, staff, facility records and a fully supplied first aid kit with manual are stored in a kitchen cabinet. LPA reviewed the administrator file and six (06) of six (06) resident records. Backyard: LPA observed a fenced in backyard with appropriate outdoor furniture. No bodies of water on the premises. Exits and passageways were clear from obstructions. The carbon monoxide detector was observed on a wall by the living room, functioning. Smoke detectors are located throughout the facility. LPA observed smoke detectors to be functioning properly. Component III was held with applicant representative/administrator. Pre-Licensing is complete and no deficiencies were observed. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted. A copy of this report was signed and provided.