Pre-licensing visit·March 3, 2026

Licensing Program Analyst (LPA) Hanna Gough made an announced visit to the facility for the purpose of a pre-licensing inspection. LPA was greeted and granted entry and met with Applicant Czarina Dumaliang. A Change of Ownership application to operate a Residential Facility for the Elderly for 5 non-ambulatory Residents and 1 bedridden Resident was submitted to CCL on March 6, 2025. The facility is a one story home with 5 resident bedrooms, 1 staff room, 4 bathrooms, living room, kitchen, dining room, and attached 2 car garage. LPA observed the See Something, Say Something poster by the front entrance to the facility. The resident bedrooms have all the required components and furnishings. LPA observed the staff room to be locked and made inaccessible to residents in care. LPA observed a clean supply of extra linens in the hall cupboards by the kitchen. LPA observed the bathrooms to have toilet paper, paper towels and nonslip mats in the shower. The water was tested to be between 116 and 116.2 degrees Fahrenheit. LPA observed the kitchen to be clean. LPA observed a 2 day perishable and 7 day non perishable food supply on hand. LPA observed the resident medications to be locked in a kitchen cupboard and made inaccessible. LPA observed a completed first aid kit located in the medication cupboard. LPA observed all appliances to be operational. LPA observed the staff and resident files to be locked in a cabinet located in the dining room. A fire extinguisher charged and with a service date of July 31, 2025, was observed in the dining room. LPA observed toxins and chemicals to be stored in a hall cupboard by the garage as well as in a locked cabinet in the garage. LPA observed an operational washer and dryer in the garage. The emergency food and water supply is stored in a cabinet in the garage. A fridge and freezer for extra facility food was observed in the garage. Applicant tested the carbon monoxide and smoke detectors and they were found to be operational. The facility has a backyard shaded seating area for resident use and no debris or obstructions were observed. The gates are operational and unlocked. Continue on LIC809C LPA reviewed the fire clearance that was approved for 5 non-ambulatory residents and one bedridden resident that was approved for room #2 on September 3, 2025. LPA conducted the Component Three Orientation with applicant. Applicant was notified that the final application approval will be issued by the Centralized Application Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided at the time of the inspection.