Pre-licensing visit·September 5, 2025

On September 5, 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, for opening an Residential Care Facility for the Elderly (RCFE). Fire clearance approved for capacity of 6 residents 60 and over residents (2-ambulatory and 4 non-ambulatory) on July 29, 2025. LPA met with Heidi Alipio, Applicant and explained the purpose of today’s visit. LPA and Applicant toured the physical plant (inside and outside). Overview of Facility: Facility is one story home located in a residential neighborhood. Entry way of the home is clear and free of debris and obstruction. There are 4 resident rooms , 2 full bathrooms, living/common room, dinning room, kitchen, wash room (located through bathroom #1), and attached garage used for storage space and extra supplies. The bedrooms are spacious and easily accommodate the residents' furnishings. 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 obstruction. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Page 1 of 3 Resident Bedrooms: Bedrooms 1-4 have working lights, working windows with no bars. There will be 2 private and 2 shared rooms. Bathrooms: All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPA observed adequate lighting throughout the entire facility. Linens & Hygiene Supplies: Extra linens are available to residents when need and located in hallway. Living/common room is fully furnished with sofa, love seat mounted TV, entertainment center and end tables and covered fireplace. Dining area is equipped with a 6 seated dinette set. There is adequate space for the residents. Kitchen is clean and sanitary with appliances that are operational. LPA observed 7-day supply of non-perishables foods and 2-day supply of perishable food. LPA observed the area where sharp objects and cleaning solutions will be locked and inaccessible to the residents in care. The Facility has a lanline phone for emergencies. There are 1 fully charged fire Extinguishers inside the home. LPA observed all required postings: See something say something, resident rights, emergency disaster plan, facility sketch and exit signs Resident/Staff files: LPA observed that there is a confidential storage area where staff and resident files will be kept. Staff files will be located cabinet in dinning area. Resident file will be kept in closet in hallway area. Page 2 of 3 Medications: LPA observed that there is a locked centralized area where residents' medications will be stored. Located in closet in hallway. Smoke Detectors: Facility smoke detectors/carbon monoxide detectors are hardwired and interconnected. They were tested and operable. Water Temperature: Tested between 105-120 degrees F. There are no corrections needed. Component III: Conducted during today’s Pre-Licensing visit. A copy of report provided to the applicant Heidi Alipio. Page 3 of 3