Pre-licensing visit·March 27, 2026

On 11/08/2021 Licensing Program Analysts (LPA) Mario Leon conducted an announced face to face visit to the facility for purpose of a pre-licensing evaluation with staff one, B RENDA HERNANDEZ MELENDEZ - Administrator (S1) The requested capacity is for five (5) non-ambulatory residents and one (1) bedridden resident RCFE (ages 60+). California Dept. of Social Services (CDSS) made the following observations: Facility is a 5 bedroom, 3 bathrooms, single-story house with an attached garage. The client bedrooms are spacious and will easily accommodate the client's furnishings. There is a backyard with a covered patio for shade. The patio contained 1 small table and 6 chairs. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. CDSS did not observe any hazards, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility . Residents Bedrooms: All 5 Bedrooms are for ambulatory clients. Bedroom’s #1, #2, #3, #5 have one bed each, bedroom #4 has two beds and #5 is to be used for any bedridden resident. There is one dresser with drawers in Bedrooms #1 -#5 which comply with the requirement of 8 cubic feet of space. 3 Bathrooms : Have a working toilet, wash basins, and Full shower. CDSS observed adequate lighting in hallway leading to bathrooms. Linens & Hygiene Supplies : Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet. Emergency Phone Numbers, Exit Plan & Menu: The telephone system is a land line and operable. Emergency Disaster Plan and "See something, say something Let Us Know" (PUB475) is visible in entry way. Fire Extinguisher number one (#1) mounted on the wall in hallway next to the kitchen, last serviced on 01/29/26. Fire extinguisher number two (#2) Report continues, please see LIC809-C. Food Service : Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet located in the kitchen area. Food supply is adequate; stored in kitchen refrigerator and cabinets and consists of the following: A variety of Fresh and Canned fruit, vegetable and meat food items. Smoke Detectors : Nine (9) hard wired operated & working. Carbon monoxide detector located and mounted above hallway entrance and is operational. Appliances: Gas Stove, oven, microwave, washer, and dryer in working condition. There are 2 refrigerators, One (1) in the kitchen and one (1) in the garage. Refrigerator in the kitchen has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at 0 zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled. Toxins : Locked/stored in the storage room located in the kitchen. Water Temperature: Bathrooms water temperature tested in #1 at 112.3 degrees Fahrenheit (°F) and #2 111.9°F. Medications, First-Aid Kit & Book : Medication administration records storage area and first aid kit has been inspected, which are stored in the office area, available for staff use but inaccessible to clients. Clients & Staff Files : Records of staff and clients shall be stored in a locked in staff closet and the section has been inspected. Reading Material, Games, Equipment & Materials : The facility has board games, books, and other recreational materials for the client's use. CDSS did not observe any pet or bodies of water at the facility, nor did not observe delayed egress, chain locks or dead bolts on exits. CDSS did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits. Pool/Jacuzzi & Pets: CDSS did not observe any pet or bodies of water at the facility. Fire clearance : Fire Clearance was approved on 02/13/26 for five (5) non-ambulatory clients and one (1) bedridden client. CDSS did not observe delayed egress, chain locks or dead bolts on exits. CDSS did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits. Report continues, please see LIC809-C. Component III: ( 03/27/26) about how to operate the facility within substantial compliance. During the pre-licensing inspection Administrator (S1) and CDSS reviewed Component III. No discrepancies were observed. There have been zero (0) deficiencies cited during today's visit. An exit interview was conducted, and a copy of this report has been provided. Accordingly, LPA Leon 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.