Pre-licensing visit·April 30, 2026

On 04/30/2026, Licensing Program Analyst (LPA) Jose Anguiano conducted an announced visit to the facility for the purpose of a pre-licensing evaluation. The pre-licensing evaluation was conducted with applicant Whitney Anderson. On 01/31/2025, an application was submitted to Community Care Licensing Division (CCLD) for Residential Care for the Elderly. The requested capacity is (6) Residents, ages 60 and over, with (5) non-ambulatory and (1) bedridden to be placed in room number 3 only. The facility is a one-story home consisting of four (3) bedrooms and two (1) bathrooms. CCLD staff conducted a review of the Physical Plant, Bedrooms, Bathrooms, Supplies, Food Service, Medications, Records, Administration, Activities, Pre-Licensing Checklist, and Component III Orientation. MEDICATIONS There is a locked, centralized storage area for resident medications inside of a office area that is locked and inaccessible to residents. PHYSICAL PLANT The facility is clean, sanitary, and in good repair. Protective devices are in place, including non-slip material on rugs. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and new and in good repair. The facility temperature is maintained between 69 degrees Fahrenheit. Stairways and areas of potential hazard are well-lit and equipped with sturdy handrails. BEDROOMS Halls, stairways, unfinished attics or basements, garages, storage areas, sheds, or similar detached buildings are not being used as resident bedrooms. Resident bedrooms are of adequate size to allow for easy passage and to accommodate furniture and assistive devices. No resident bedroom is a passageway to another room, bathroom, or toilet. Each resident has a bed with a mattress, mattress pad, bedsprings, and pillows, all of which are clean and in good repair. Mattresses and pillows are flame-retardant. Each resident has dresser and closet space. A chair and lamp are provided for each client, and at least one (1) night stand is provided per resident in care. BATHROOMS There are two (2) toilets and washbasins available for client, family, and personnel use. There is at least one (1) shower or bathtub per ten (10) residents, family, and personnel. The hot water temperature was measured at 117 degrees Fahrenheit. Bathrooms are located near client bedrooms. SUPPLIES Client personal hygiene supplies are available, including soap, toothpaste, toilet paper, and combs. There is a sufficient supply of clean linens to permit weekly changing, or more often as needed, including top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE The dining room is located near the kitchen. Refrigerators and freezers are clean and of sufficient size to store at least two (2) days of perishable food. The freezer temperature is maintained at 0 degrees Fahrenheit, and the refrigerator does not exceed 40 degrees Fahrenheit. A seven (7) day supply of non-perishable food is available. The kitchen, including all equipment, dishes, utensils, food storage, and preparation areas, is clean and in good repair. RECORDS Confidential storage of personnel records is maintained at the facility. Confidential storage of resident records is also maintained in the office area. Please see (LIC809-C) for report continuation. ADMINISTRATION The emergency exit plan and emergency phone numbers are posted. Resident Personal Rights are posted, which meets the requirement. The facility visiting policy and Licensing Complaint Poster are posted. Space is available for resident council meetings and postings. ACTIVITIES There is outdoor activity space available with two (2) shaded areas, furnished for outdoor use. There is at least one common room available for residents to receive visitors. MISCELLANEOUS First-aid supplies are available, including sterile dressings, bandages, adhesive tape, scissors, tweezers, a thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment available for laundry. Separate areas are designated for clean linen storage and soiled linen. There is an operating telephone available to residents. Emergency lighting and supplies, including flashlights with batteries, are available. COMPONENT III Component III was provided in person. Information was reviewed with the applicant regarding operating the facility in substantial compliance. An exit interview was conducted, and a hard copy of this report was provided to the applicant. Accordingly, the LPA will submit a copy of this facility evaluation 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 contact the assigned CAU Analyst.