Pre-licensing visit·July 30, 2025

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility was greeted and granted entry. LPA met with Stevelyn Reroma, Administrator and explained the visit. A change of ownership application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden resident was submitted to CCL on 10/08/24. Structure: The facility is a one story house with an attached garage with 5 resident bedrooms, 3 full bathrooms, 2 half bathrooms a living rooms, a dining room, and a kitchen. The residents’ bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large back yard with a covered patio and one exit walkway on one side of the house with seating for the residents. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with 4 private rooms and 1 shared room accommodating two residents. Bedroom 5 approved for one bedridden resident, bedroom 3, 4, & 6 approved for one non-ambulatory resident, and bedroom 1 approved for two non-ambulatory residents. Bedrooms 1 has a half bathroom, bedrooms 2 and 3 share a half bathrooms . Bedrooms Staff: Designated bedroom for live-in staff. Bedroom 2 is a staff room. Bathrooms: Facility has three full bathrooms and two half bathrooms. All bathrooms have a working toilet, wash basin, walk in Continued on LIC809-C shower. Linens & Hygiene Supplies: Adequate supply of linen in closet storage in cabinet located in garage. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen with non-perishables stored in garage. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested, and found operational. 2 fire extinguishers mounted in living room and resident bedroom hallway charged and dated 7/30/25. Appliances: Gas five burner stove, single oven, 2 refrigerator (kitchen and garage), microwave, dishwasher, washer, and dryer are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents are stored and locked underneath kitchen sink and garage. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 106.7 Fahrenheit degrees in facility bathrooms. Medications, First-Aid Kit & Book: Medication and first aid manual stored in a locked kitchen cabinet and First Aid kit stored in bedroom hallway cabinet located in front of bedroom 5. Resident & Staff Files : Records will be kept locked in a cabinet located in the bedroom hallway in front of bedroom 5. Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents’ use, commensurate with the plan of operation. Fire clearance: Was approved on 11/13/24. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.