Pre-licensing visit·May 9, 2025

Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Licensee/ Administrators Luis Lucero and Jeffrey Gardner. An initial application to operate a Residential Care Facility for the Elderly was submitted to Community Care Licensing on 07/05/2024 for a capacity of five non-ambulatory and one bedridden resident. Upon entry, facility appears clean, safe and sanitary. Facility has all required postings including personal rights, admission agreements and theft and loss policy. Administrator Luis Lucero has an administrator certificate expiring on 07/18/2025. LPA Lyman along with Licensee/ Administrators Lucero and Gardner toured the facility at 7:50 AM and observed the following: Structure: Facility is a one story, five bedroom, four bathroom house as well as a den with a tan exterior and attached garage. There is an enclosed front patio with seating for residents. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms will be single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Exit doors have auditory exit alarms. Linens & Hygiene Supplies: Facility has ample bedding and towels in supply. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: Facility has a small amount of food on-site due to no residents currently residing at facility. Facility to obtain perishables and non-perishables upon licensure. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguishers are fully charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. CONTINUED ON LIC 9099C DATED 05/09/2025 Toxins / Sharps : Facility has secured areas for toxins and sharps. Water Temperature: Tested and recorded between 111 and 114.4 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water as well as a posted emergency disaster plan. Facility is equipped with solar power as well as backup battery for emergencies. LPA observed night light in facility hallway. Medications, First-Aid Kit & Book: First aid kit observed contained all required items including tweezers, scissors and thermometer as well as a first aid manual. Medication to be stored in a locked cabinet. Facility will use a medication administration record. Resident & Staff File: Records are to be stored in a secured file cabinet. Reading Material, Games, and Equipment: LPA observed a sample activity schedule with activities such as games and exercise. Backyard : LPA observed a clean backyard with ample shaded seating for residents. Fire Clearance: Approved for five bedridden and one ambulatory resident on 08/05/2024. Component III conducted during the visit. Facility is ready to be licensed. Exit interview conducted and a copy of this report was left at the facility.