Pre-licensing visit·April 7, 2026

At approximately 8:30AM, Licensing Program Analyst (LPA) Felias arrived announced to conduct a pre-licensing inspection visit and met with Applicant, Stephanie Ellazar , and Staff Member, Gigi Borja. Facility intends on providing care and assistance to older adults and will have a dementia program plan on file. Facility received an approved fire clearance dated 03/03/2026 that allows for a total capacity of 6 non-ambulatory clients. Facility submitted their emergency disaster plan and infection control plan which was last reviewed on 03/02/2026. Per conversation with Applicant, they have requested for a hospice waiver for 6 individuals. LPA conducted a tour and inspection of the indoor and outdoor portions of the facility. Per facility sketch, facility consists of 5 resident bedrooms, 2 bathrooms, and common spaces. Facility garage was converted into office and storage spaces. Per Applicant, the office and storage spaces in the facility sketch are intended to be for staff members only, consisting of an main office area, laundry, and two live-in staff rooms. LPA requested for an updated facility sketch and fire clearance to be submitted to accurately reflect the home's layout. LPA received updated facility sketch during visit. Applicant contacted the Marin Fire Department who stated they could reassess the home today, 04/07/2026. Facility was found to be clean and at comfortable temperature with all exits free from obstruction. Resident rooms were observed to have appropriate furnishings per Title 22 Regulations. Facility's fire extinguisher was located by the main entryway and was last inspected December 2025. Cleaning products and other toxins and chemicals were observed to be locked under one of the bathroom sinks. Kitchen knives and other sharps were observed to be in a locked kitchen cabinet. Facility was observed to have appropriate linens and paper products available for resident use. Applicant intends on storing resident medication, resident files, and staff files in the converted garage. Hot water temperatures for facility sinks were found to be out of compliance with Title 22 Regulations of 105F to 120F measuring at 145.2F, 138.2F, 149.3F, and Continued on LIC809C Continued from LIC809 149.1F. Facility was observed to have some nonperishable and perishable foods on hand and had sufficient items for eating. LPA observed 3 pots and 1 saute pan on-site. Facility to purchase additional nonperishable items to meet 7-day requirement and more cookware. Facility's smoke detectors and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid kit was sufficient. Facility to install landline telephone for resident use. Facility had required posters displayed. LPA observed un-installed ramp railings and other items being stored against the side of the house in the backyard. LPA did not observe any pathways obstructed. Component III was reviewed with Applicant and Staff Member. Applicant to submit photos and/or documents of the following corrections: Updated and approved fire clearance 3 day water temperature log showing temperatures within Title 22 Regulations of 105F to 120F. Removed items observed in the backyard against the house Installed railings for outside ramps Installed landline for resident use Proof of nonperishable goods to meet 7 day requirement Proof of enough cookware/pots/pans Ensure that Live-In Staff personal items are removed from resident rooms Photos to be submitted to the Department by end of business on Friday, 04/10/2026. Pre-Licensing completed and Advisories Issued. Facility is ready to be Licensed as a Residential Facility for the Elderly (RCFE) once photos and documents have been received and reviewed. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. Copy of report discussed and provided to Applicant. Signature on form confirms receipt of documents.