Pre-licensing visit·April 7, 2025

On April 7, 2025 Licensing Program Analyst (LPA), Deborah Lee conducted an announced visit to the facility for the purpose of conducting a pre-licensing evaluation. An application was submitted to CCLD on October 22, 2024, for opening a new facility for an Adult Residential Care Facility for the Elderly (RCFE) to serve 5 non-ambulatory residents; 1 could be bed ridden. Fire clearance approved on February 26, 2024. LPA met Andrea Carbajal applicant, and explained that the purpose of today’s visit. LPA and Applicant toured the physical plant(inside and outside). Overview of Facility: Facility is a single-story home located in a residential neighborhood. Entry way of the home is clear and free of debris and obstruction. There is a separate resident entrance on side of home that is accessible to the home. LPA observed a sanitation station and visitor sign-in as you enter the facility. There are 5 resident bedrooms, 3 bathrooms, dining room, living room, laundry room, and attached garage that will be used for storage and extra food items. The Resdients' bedrooms are spacious and can easily accommodate the client's furnishings. ** Amended to obtain signatures LPA observed that there are no bodies of water on the premises. The shaded area and outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPAs did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Bedrooms Residents: Bedrooms 1-5 have working lights, new blinds and working windows with no bars. 4 bedroom will be private rooms/occupied by 1 resident and 1 shared occupied by 2 client. Bathrooms: All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPAs observed adequate lighting throughout the entire facility. Linens & Hygiene Supplies : Extra linens are in linen closes located in hallway next to bathroom #1. Living room The Living room is fully furnished with sofa, 2 recliners, TV, lamp, covered fire place. The dining area is equipped with 6 seated dinning set, cabinet and printer. Facility has a lanline phone for emergencies. There is 1 fully charged fire Extinguishers located in the kitchen area. LPA observed all required postings: See something say something, clients rights, activity schedule, emergency disaster plan, facility sketch menu (posted on refrigerator). Smoke Detectors: Facility has 7 smoke detectors/carbon monoxide detectors are hardwired and interconnected. They were tested and operable. Appliances: LPA observed all kitchen appliances and washer and dryer in working order. LPA observed a 7 day supply of non-perishables and 2 day supply of perishable food items. The residence is equipped with heat and air conditioning. Toxins: Applicant showed LPA, where toxins to be locked/stored. Water Temperature: tested at 109 degrees F. Residents & Staff Files : Resident and staff files will all be stored in locked cabinet located in the dining area. There are no corrections needed. Component III: Conducted during today’s Pre-Licensing visit A copy of this reported provided to Andrea Carbajal, Applicant.