Pre-licensing visit·May 11, 2026

On 5/11/2026, at approximately 09:40 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an announced Pre-licensing visit. LPA met with the Administrator, Jose Chito L. Mendoza. An application was submitted to Community Care Licensing Division-CCLD on 08/07/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for one (1) ambulatory and five (5) non-ambulatory, a total of up to six (6) residents. The fire clearance was approved on 10/20/2025. Structure: The facility is a single-story building with four (4) bedrooms and two (2) bathrooms. There is a designated staff room. Entrance: Upon entrance, required postings such as: Personal Rights of Residents, Emergency Disaster Plan, and See Something Say Something were observed. Common Areas: The common areas include: the living rooms and the dining room. The rooms were observed to be neat, clean, and organized with sufficient seating for both residents and staff. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature of sixty-eight (68) degrees. No firearms were observed or will be maintained on the premises. LPA observed a working telephone to be located in the living room. Resident/staff files: The resident and staff files will be kept in either the staff reception area located near the kitchen or in a locked cabinet located near the medication. Files will be kept in a locked cabinet inaccessible to Residents. LPA observed a complete First-aid kit not limited to tweezers, bandages, and scissors. LIC809C-continued Medications: The medication will be stored in a locked cabinet located near the kitchen. Medication storage was observed to be equipped with a lock to ensure medications will not be accessible to residents. Kitchen: The kitchen was observed to be equipped with sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods will be purchased prior to residents’ arrival. Sharps were observed to be stored in kitchen drawer locked and inaccessible to the residents. The cleaning solutions and toxins were observed to be kept in locked cabinet underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Emergency: The Fire extinguisher was observed to be located near the kitchen and dated 10/11/2025. Bedrooms: The bedrooms were observed to be properly furnished with bed, nightstand, applicable lighting, and seating. Window coverings are in good repair, not broken or damaged. Bathroom: The bathrooms were observed to be in proper condition. Towels and washcloths will not be shared. Appropriate grab-rails and slip-resistant mats were observed and in proper condition. Staff room: The staff room/office was observed to be located near the kitchen, Staff room was observed to be kept locked. Hallways: The hallway was observed to be properly lighted. LPA observed extra linens/covers stored in cabinet within the hallway’s passageway. Laundry: The laundry was observed to be located near the kitchen leading towards the staff room/office. Dryer and washer were observed to be in proper condition. The Garage: The garage can be accessed from inside the facility. The garage was observed to be kept locked and used for storage purposes. The garage will be used for extra storage, cleaning solutions, Laundry detergents, extra food for emergencies, and/or extra personal hygiene supplies. Water Temperature: The water temperature was measured in the bathrooms and observed to be within regulations. LIC809C-continued Smoke detectors: The smoke detectors and carbon monoxide were observed to be working properly and were tested at 11:00 am. LPA observed one (1) fire door to be working and in proper condition. Outside: The outside was observed to be clean, free of hazards, and properly furnished with sufficient seating. Exercise equipment was observed near the shaded seating area. The equipment was observed to be in proper condition. LPA observed a shaded area for residents. LPA observed there to be two (2) locked sheds. Pool: LPA observed there to be no body of water located within the premises. Administration: The facility had submitted an Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. The Component III Orientation RCFE was shown/reviewed with the Administrator. The facility was observed to be in compliance with Title 22 Regulations at the time of the visit. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issued to the Administrator.