Pre-licensing visit·February 10, 2026

Licensing Program Analyst (LPA) Andrea Mendivil made an announced visit to conduct a pre-licensing inspection. LPA identified themselves and discussed the purpose of the visit with Licensee Fredric Robart an initial application to operate a Residential Care Facility for the Elderly application was received by CCL on 05/15/2025, for a capacity of six residents, 4 non-ambulatory and 1 bedridden resident, and 1 ambulatory resident. LPA Mendivil along with Licensee toured the facility at 09:05AM and observed the following: Structure: Facility is a single story, 5 bedroom, 2 bathroom house with breezeway used as office and attached garage and white exterior. The exit gates are unlocked and self latching. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: 2 bedrooms are single occupancy and 2 rooms are shared. There is 1 staff bedroom. All of the rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Resident bathrooms have a working toilet/ wash basin . Linens & Hygiene Supplies: Facility has bedding and towels for residents in care. Emergency Phone Numbers and Exit Plan: Posted in facility hallway Food Service: Licensee has 2 day perishable and 7-day nonperishable foods. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested and operational. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : LPA observed a secure area for sharps and toxins. Water Temperature: LPA tested hot water and it read as following: residents bathroom tested between 106.7 and 107 degrees Fahrenheit . Emergency Supplies: LPA observed supply of emergency water and food stored in facility garage. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. CONTINUED ON LIC 809C DATED 02/10/2026 Medication is stored in locked cabinet in facility breezeway. Resident & Staff File: Records are stored in a locked cabinet Reading Material, Games, and Equipment: . LPA observed games and coloring books in facility. Backyard : LPA observed a shaded area for residents. Fire Clearance: Approved for 1 ambulatory, 4 non-ambulatory and 1 bedridden residents on July 9th 2025. Facility is ready to be licensed. Component III completed. Exit interview conducted and a copy of this report was left at the facility.