Pre-licensing visit·March 5, 2026

Licensing Program Analyst (LPA) Galarza made an announced visit and met with Licensee Tiffany Montoya. An application was submitted to Community Care Licensing Department (CCLD) for an initial application of a Residential Care Facilities for the Elderly (RCFE) to serve adults ages 60 and over. The plan of operation includes a Dementia Care program and a hospice waiver for four (4) residents. The requested capacity is for five (5) non-ambulatory, of which one (1) may be bedridden in room #3. Structure: Facility is a single-story home located in a residential area consisting of three (3) bedrooms, of which bedroom #3 is designated for bedridden residents, living room, 2 full bathrooms, 1 half bathroom, kitchen, 2 dining rooms, den, office, laundry room, storage room, attached garage, and backyard with a fenced pool and covered patio area. Front yard is landscaped with grass. Doors and windows have auditory alarms. Bedroom Clients: Each bedroom is designated as shared bedrooms. Bedrooms are equipped with one bed, night-stand, chair, lamp, and overhead lighting. Bathrooms: Two (2) full bathrooms and one (1) half bathroom are equipped with working toilets, wash basins, bathtub/ walk-in shower. Linens & Hygiene Supplies: All beds had required linen/supplies which include, pillowcase, fitted sheet, blanket and bedspreads, but did not have mattress pads. Adequate supply of linens is stored in hallway closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. Two (2) fire extinguishers were observed. Facility has a land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Emergency water supply was observed. Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator , oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff. ***Narrative continues next page.**** Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and the first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Clients & Staff Files: Designated area for files will be in the office. Pools/Jacuzzi/Body of Water & Pets : The backyard has a fenced pool. No health and safety concerns were observed. Fire Clearance : Fire clearance was approved on 2/12/2026 for 5 non-ambulatory, of which 1 may be bedridden in rooms # 3. Component III: Component III was waived. Applicant is presently a Licensee of other RCFE's. The following items must be corrected and proof of correction shall be submitted to the CCLD office to the attention of LPA Galarza by 3/13/2026. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date. Some items may require a follow up inspection for verification of correction. 1. All beds need mattress pads. 2. R esidential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. T he poster that is posted shall be 20” x 26 ” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 3. Backyard patio area has discarded debris i.e.,patio paver floor located in the rear left is not cleaned, gas tank, pool accessories, and torn bench shade. An exit interview was conducted and a copy of this report has been furnished to Tiffany Montoya. 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.