Pre-licensing visit·December 4, 2025

On 12/04/2025 Licensing Program Analyst (LPA) Mario Leon conducted an announced pre-licensing visit using the CARE Inspection Tool. LPA was met by staff one, Tina Cinco (S1) and the purpose of the visit was explained. An application was submitted to CCLD on June 18, 2025, for opening a new facility for an Adult Residential Care Facility for the Elderly (RCFE) to serve six (6) non-ambulatory residents aged sixty (60) and above; Hospice waiver granted for six (6). Fire clearance approved on February 29, 2025. LPA was met by Tina Cinco applicant, and explained that the purpose of today’s visit. LPA and Applicant toured the physical plant (inside and outside) with S1. The facility consists of the following: 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, kitchen and an attached garage that will be used for storage and extra food items. The Residents' bedrooms are spacious and can easily accommodate the client's furnishings. There are two, shaded, patios in the rear and a driveway along the west-side of the house. Both sides of the house are designed for emergency exits for all non-ambulatory residents. All rooms, aside from the exit of living room, are designed for non-ambulatory residents with padded ramps. 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. 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. Report continues, please see LIC809C. Bedrooms Residents: Bedrooms number(s) one (#1) through five (#5) have working lights, new blinds and working windows with no bars. Bedrooms #2 through #5 will be private rooms/occupied by single (1) resident and bedroom #1 will shared occupied by two (2) resident(s). 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 in linen closes located in hallway next to bedroom #2, while all detergents are stored either in the kitchen or the detached garage Living room The Living room is fully furnished with sofa, one love seat and a chair, TV, lamp, covered fire place and a fully charged fire extinguisher, last serviced July 10, 2025. The dining area is equipped with six (6) seated dining chairs, cabinet and printer. Facility has a lanline phone for emergencies. There is 1 fully charged fire Extinguishers located in the kitchen area, last serviced July 10, 2025. 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 nine (9) 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-perishable and 2 day supply of perishable food items, stored in the kitchen. The residence is equipped with heat and air conditioning. Toxins: Applicant showed LPA, where toxins to be locked/stored either in the kitchen or the attached garage. Water Temperature: tested at 106.2 degrees F, within title 22 regulation(s). Residents & Staff Files : Resident and staff files will all be stored in locked cabinet located in the kitchen area. There are no corrections needed. Prelicensing Component III: all staff present have acknowledged awareness. An exit interview was conducted and a copy of this report has been furnished to the applicant, S1. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) 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.