Pre-licensing visit·April 2, 2025

On 04/02/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an announced pre-licensing visit to this home. LPA was greeted by applicant/Licensee Chilly Navarro, Co-Administrator Kimberly Tad-y, Co-Administrator Czarina Serrano, and Facility Manager Michelle Aspiras. LPA explained the purpose of today’s visit and was given access to the facility. An application was submitted to CCLD on 06/01/24 for an initial license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of four (4) individuals, of which maybe four (4) non-ambulatory. Structure: This home is a single-story structure located in a residential neighborhood and consist of the following: three (3) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, kitchen, dining room and a dining area, office space, a garage with laundry space and indoor/outdoor activity area and backyard. Continued on LIC809-C Living room fireplace had a bolted-on screen. The living area included sectional seating. The kitchen has a refrigerator and stove. Passageways, walkways, and steps inside and out are free from obstructions. Bedrooms Residents: The facility has three (3) bedrooms for residents and one (1) staff bedroom/lounge. Two rooms include a bed, chair, nightstand. One room had two beds, two chairs and two bedside tables. All bedrooms are equipped with ceiling lights and dressers, which comply with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. Bedrooms Staff: Bedroom 4 is designated for staff. Bathrooms: The home has three (3) bathrooms. All bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats. Continued on LIC809-C Linens & Hygiene Supplies: Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the hall closet. Emergency Phone Numbers, Exit Plan & Menu: Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There are two (2) fire extinguishers, one located on the wall in the dining room, and one located on the wall in the kitchen. Facility has a working telephone which was called by LPA and found to be operational. Emergency supplies and Personal Protective Equipment supplies are stored in a closet located in the living room area. The applicant as an approved Infection Control Plan on file. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked box in a locked kitchen drawer. Food supply is adequately stored and consist of (2) day supply of perishables and a (7) day supply of non-perishables. The kitchen counters also had small appliances. Smoke Detectors : Smoke/ Carbon Monoxide detectors were operable. Toxins: All toxins are locked and stored in a cabinet located in the garage. Appliances: Kitchen appliances found to be within title 22 requirements. Home is equipped with central heaters and air conditioning systems. Water Temperature: The water temperature was found to be withing title 22 regulations throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in a cabinet located in the kitchen and contained thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to residents. The resident's medications will be stored in a cabinet locked in the kitchen area and inaccessible. Resident & Staff Files: Records of staff and residents will be stored in cabinets in the staff bedroom/lounge. Reading Material, Games, Equipment & Materials: The facility has board games, books, magazines, and other recreational materials for the resident's use all stored in the living room. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool on premises. A Fire Clearance inspection was conducted on 12/11/25 and approved for a capacity for four (4) non-ambulatory residents. Component III Orientation: Component III was completed with the Applicant during the Pre-Licensing visit. Information was provided about how to operate the facility within substantial compliance. When the applicant was asked if she understood Title 22 Regulations he responded in the affirmative. Exit interview was conducted, and a copy of this report was provided to Licensee. LPA will submit a copy of this report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.