Pre-licensing visit·October 31, 2025

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Administrator (AD) Genesis Johnson. An application to operate a Residential Care Facility for the elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on February 13, 2025. Structure: The facility is a one-story house with five resident bedrooms, three bathrooms, two living rooms, a kitchen, a dining room, a laundry room, and de-attached two car garage used for storage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the living room. There is a bisected backyard, and the back portion of the yard is inaccessible to residents and staff. The front portion of the backyard has a side exit gate and a shaded seating area for resident use. LPA did not observe any obstacles or hazards in the backyard. Resident Bedrooms All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Signal system There is no signal system. Medications, First-Aid Kit & Book: Medication will be stored in a locked medicine cart. First aid kit is stored with the medication. The first aid kit has all the required elements. Resident & Staff Files : Records will be kept in a locked file cabinet. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: Fire extinguisher is fully charged. Reading Material, Games, Equipment & Materials: The facility has magazines, board games, puzzles, and other recreational materials for resident use stored in the living room. Fire clearance: Was approved by a fire inspector of the Anaheim Fire Department on May 6, 2025. Special conditions noted, “Bedridden in room #3.” Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. Bedrooms Staff: There are staff bedrooms. Bathrooms: All bathrooms have working plumbing. Hot water measured between 111.3-112.8 - degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in the hallway storage. Emergency Phone Numbers, Exit Plan & Menu: Posted and available, means of exiting, and emergency phone numbers. Food menu is also posted and available for review. Food Service: A supply of 2-day perishable and 7-day of non-perishable food will be maintained on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational. Appliances: Gas burner stove, refrigerator, microwave, washer, and dryer are operational. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided at the end of the inspection.