Pre-licensing visit·October 2, 2025

Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Licensee (LE) Maria Jasmin Avila and Administrator (AD) Sheila Ben. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on April 4, 2025, for a total capacity of six non-ambulatory of which one maybe bedridden in Room #1. The fire clearance was approved by a fire inspector from the Orange County Fire Authority on April 29, 2025. The facility is a one-story home with four resident bedrooms, three bathrooms, living room, kitchen, and dining area. There are two exit gates on both sides of the house that are self-latching and unlocked. There is a shaded seating area for clients in the shared yard with their sister facility. LPA did not observe any obstacles or hazards. There are activities such as games and puzzles for residents to play and participate in. LPA observed Administrator certificate, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall in the front part of the house. The See Something, Say Something poster (PUB 475), Long Term Care Ombudsman poster, and Personal Rights were posted up on the walls of the front entry way. Resident bedrooms had the required furnishings. The bedroom with a door to the backyard had a working door alarm. LPA observed all beds had linens and blankets. There is an ample supply of linens and towels. Smoke detectors and carbon monoxide detectors tested operational. Hot water temperatures in the bathrooms measured between 114.2 to 114.8 Fahrenheit degrees. Bathrooms were observed to be operational and have a working toilet, wash basin, and bathtub/shower, as well as grab bars and non-skid surface mats. Toxins are secured and locked in a backyard shed. (Pre-licensing Report continuation on LIC809-C) Medications will be stored in a locked cabinet by the kitchen area. The first aid kit with all the required elements and first aid guidebook was observed in the medication cabinet as well. Records will also be stored alongside medication in the locked cabinet. A phone is in the kitchen for residents to use. The facility also has a tablet for residents to use and keep in touch with family. A supply of perishable and non-perishable food was observed. Electric stove burners, refrigerator, microwave, washer, and dryer are operational. Sharps are stored in a container, locked and secured underneath the kitchen sink. Emergency food and water and additional supplies were observed to be well stocked in the pantry. The fire extinguisher in the kitchen is fully charged and last serviced on March 25, 2025. The facility is ready to be licensed. LPA conducted the Component Three Orientation with Licensee Maria Jasmin Avila and Administrator Sheila Ben. Facility 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 to the Licensee and Administrator.