Pre-licensing visit·November 24, 2025

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an announced visit to the facility for the purpose of a Pre-licensing inspection. LPA met with Applicant Tiffany Montoya. The facility has an approved fire clearance to be licensed to serve six (6) non-ambulatory residents age range 60 and over of which one (1) may be bedridden. Bedroom #2 with direct exiting to the exterior shall house the bedridden resident. The facility is a single-story home located in a residential area of Glendora. The home consists of kitchen, dining area, living room, den, three (3) bedrooms, two (2) bathrooms, backyard and garage with laundry area. LPA and Applicant toured the physical plant interior and exterior. The Pre-Licensing Inspection CARE Tool was used, and the following was observed: Infection Control: Facility has an Infection Control Plan in place. Physical Plant and Environmental Safety: Appliances such as a microwave and stove were observed to be clean and operating properly. Freezer of adequate size maintained and refrigerator of adequate size observed to be clean and operating properly. Kitchen area was observed to be clean and free of litter, rodents, vermin and insects. Containers storing waste were observed in good repair, free of leaks. continued on LIC 809C continued from LIC 809 (page 2) Sharps secured in a locked kitchen cabinet, inaccessible to residents. Disinfectants, cleaning solutions, and poisonous substances stored in areas separate from food supplies. Telephone service on the premises A comfortable, appropriately furnished living room and en, available to all residents for their relaxation and for entertaining friends and relatives, was observed with games and magazines. Dining area was clean with sufficient seating. Fireplace in the living room had screened covering. Combination smoke/carbon monoxide detectors located throughout the facility are interconnected, were tested and are operable. Laundry room observed in the garage included a locked cabinet for detergents. Washing machine and dryer were observed to be in good repair. Two (2) fire extinguishers observed and charged. Resident bedrooms all have required furniture which includes, for each resident; a bed, a chair, nightstand, and lights sufficient for reading. Bed linens were clean and in good repair. There is closet space for clothing and other belongings. Extra linens and towels observed in hall closet. Water temperature was tested and measured at 133°F, which is above the required 105°-120°F in both bathrooms. Applicant adjusted at time of visit. Grab bars were observed in showers and by toilets in bathrooms used by residents. Slip-resistant flooring was observed in shower floors. Residents Rights: Personal Rights are posted in common area. Centrally stored medication will be located in a locked kitchen cabinet, inaccessible to residents in care. The first-aid kit and manual were observed and kept in the kitchen. Outdoor activity area that is easily accessible to residents, protected from traffic, and adequate shady area was observed. Doors, exits, hallways, and passageways were clear and free of obstruction. No pools or large bodies of water were observed. Continued LIC809C page 3 Disaster Preparedness: Facility has Emergency Disaster Plan LIC 610 in place. Applicant will add an addition temporary location, outside the immediate area where facility is located. The Pre-licensing inspection is completed. Comp III was waived, applicant completed Comp III at the Riverside RO June 2025. Exit interview was conducted with applicant Tiffany Montoya and a copy of this report was provided. 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.