Pre-licensing visit·November 20, 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 Administrator Kyle Coleman. An initial application to operate a Residential Care Facility for the Elderly was submitted to Community Care Licensing on 05/09/2025 for a capacity of sixty eight non-ambulatory and four bedridden residents. Upon entry, facility appears clean, safe and sanitary. Facility has all required postings including personal rights, theft and loss policy, and the complaint poster. Administrator Kyle Coleman has an administrator certificate expiring on 09/26/2027. LPA Lyman along with Administrator Coleman toured the facility at 8:27 AM and observed the following: Structure: Facility is a one story building housing residents and a separate building for administrative offices. Living Room/ Dining Room : Adequate seating is available in the dining room and common areas. Bedrooms Residents: Rooms are single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Restrooms and bedrooms have fall monitoring technology. Linens & Hygiene Supplies: Facility has ample bedding and towels in supply as well as hygiene supplies. Bathrooms: All resident bathrooms have a working toilet/ wash basin. There are multiple common shower/ restrooms for residents. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: LPA observed the kitchen and serving area. Facility has ample food and water in supply. LPA observed temperature logs are being utilized. Smoke Detectors: Smoke detectors and fire inspections are conducted quarterly by an outside company, Cal Building Systems. Facility tested fire system during the visit and alarms were operational as well as exit gate attached to alarm. Fire extinguishers are fully charged. Appliances: Kitchen and laundry appliances are operational. CONTINUED ON LIC 9099C DATED 11/20/2025 Toxins / Sharps : Facility has secured areas for toxins and sharps. Water Temperature: Tested and recorded between 107.2 and 118 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water as well as emergency supplies. 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. Medications are stored in locked medication carts. Facility uses an electronic medication administration record. Resident & Staff File: Records are to be stored in the medication room or business office. Reading Material, Games, and Equipment: LPA observed a posted activity schedule with activities such as games and exercise. Outside areas : LPA observed an outside area with ample shaded seating and a walking path. Fire Clearance: Approved for sixty eight non-ambulatory and four bedridden residents along with delayed egress on 06/25/2025. Facility has four rooms with specialized fire alarms for the hearing impaired. 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.