Pre-licensing visit·September 30, 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) Ana Joy Cacho. 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 July 2, 2025. Structure: The facility is a one-story house with four resident bedrooms, two bathrooms, living room, kitchen, dining room, and attached two car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is a backyard with a shaded seating area and an exit gate on each side of the house. Resident Bedrooms All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Signal system There is no signal system. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink. Medications, First-Aid Kit & Book: Medication will be stored in a locked cabinet. First aid kit is stored with the medication. First aid kit was observed to have all the required elements. Resident & Staff Files : Records will be kept in a locked cabinet. Pool/Jacuzzi: There is an in-ground pool in the backyard enclosed by a bar fence five feet in height with a gated door that is self-latching. Latch is located within 6 inches from the top of the gate. Fire Extinguisher: Fire extinguisher is fully charged with service tag dated January 13, 2025. Reading Material, Games, Equipment & Materials: The facility has board games, card games, puzzles, and other recreational materials for resident use stored in the dining room Fire clearance: Was approved by a fire inspector of the Anaheim Fire Department on August 18, 2025. Special conditions noted, “Garage shall be used for storage only. Facility is approved for 5 non-amb/1 bedridden. Bedridden (1) only allowed in bedroom 2, not approved for more than 1 bedridden.” Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. Bedrooms Staff: There is no staff bedroom. Bathrooms: All bathrooms have working plumbing. Hot water measured between 110.8- and 112.1- 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 visible. Food Service: A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational. Appliances: Gas stove, refrigerator, microwave, washer, and dryer are operational. Licensee to address the following corrections by October 15, 2025: · The See Something, Say Something poster (PUB 475) was observed to be posted on the wall in the entranceway, however, is not 20" x 26" in size as required by regulation. · The freezer was observed to be soiled with dark colored dried fluids and contained undated frozen poultry. Designated AD stated freezer will be cleaned and items dated. · The backyard was observed to contain a discarded mattress at the entrance of the pool gate and bed frames, chairs, and a commode by the storage shed located at the back corner of the backyard. Designated AD stated items will be discarded. LPA will make an additional announced visit to follow-up on corrections listed above. An exit interview was conducted, and a copy of this report was provided to designated AD.