Pre-licensing visit·February 26, 2026

***This report supersedes the Prelicensing report on 02/23/2026. *** At 9:50 am Licensing Program Analyst (LPA) Tihesha Smith made an additional announced visit to this facility to address additional concerns observed during review of pre-licensing information. On 02/23/2026 at 09:55 am Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing visit at this facility. The administrators’ identity was verified by CA photo ID. The facility has a capacity of six (6). 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 Smith touring the physical plant inside and outside and the following was observed: The common areas (kitchen, living room, and dining areas were appropriately furnished, and lighting was adequate. The facility has some perishable and non-perishable food supply with emergency supply /water kitchen pantry. Appliances in the kitchen appeared to be functional. The living room has a television and comfortable furniture. Games and activities for residents are stored on the console table. There is one (1) fire extinguisher: attached to living room wall and was observed to be fully charged. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at time of visit. Emergency exit plan/sketch is posted near the entrances and in the bedrooms with other posting requirements on dining area wall. (cont from 809) There are two (2) bathrooms in the facility with one (1) of the bathrooms located inside a bedroom. The hot water was tested for the bathrooms and measured 109.0 and 110.7 °F. Bathrooms have trash cans, nonslip mats and functional grab bars. The sharps are stored and locked in kitchen pantry. The medications and first aid are locked in stand-alone cabinet near dining room table and medication refrigerator. Laundry room is in detached room near patio. The laundry appliances observed to be in good repair. Linens are stored in hall closet next to main bathroom. Staff and residents’ files stored in stand-alone cabinet in living room. There is no body of water at the facility. Backyard has a pergola with table, sufficient seating and is in good repair. Detached garage is not part of the facility. The following were discussed during the visit: Removal of bricks around front of property/side gate and crawl space nail Purchase additional dresser Purchase cover for pergola Add/replace door threshold transitional strip Wipe down all appliances Component III presentation completed at approximately 11:07 a.m. and administrator acknowledged understanding. (cont from 809C) Today’s visit addresses the following: No tenants on premises once licensed A new facility sketch is required to add laundry room and designate rooms to non-ambulatory Designate former tenant section/storage and garage and note on facility sketch if either will be part of the facility Resubmit page 3 of the 610E as #3 exit list master bedroom window as an exit Cut grass in front yard Another visit will be required to inspect tenant section/storage, garage and front yard issues Copy of this report will be forwarded to the CAB specialist. Exit interview was conducted and a copy of report was issued