Pre-licensing visit·October 3, 2025

Licensing Program Analyst (LPA) Garlli Tat conducted an announced pre-licensing visit to the facility and was greeted and granted entry by applicant Polly Valencia. LPA reviewed the Administrator's Certificate that expires on January 5, 2026. LPA toured the exterior and interior portion of the facility with Polly Valencia. Facility is a single-level structure home. On August 27, 2025, The Orange County Fire Authority granted fire clearance for a capacity of six residents (all of which may be non-ambulatory and a request for hospice waiver for two has been granted). There are a total of four bedrooms, two of which are private resident rooms and two shared resident bedrooms. There is an office and an attached garage that is utilized for storage. All bedrooms were provided with brand new furniture, in good repair, clean linens, adequate storage space, and kept hazard free. The bathrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in residents' bathrooms were measured between 108.5 to 108.8 degrees Fahrenheit. Adequate supply of brand new linens are stored in the garage. LPA observed the PUB475 "See Something, Say Something" poster posted by the dining room. Emergency disaster plan is posted in the dining room. Facility met the minimum seven day non-perishable food supplies. Applicant reported that two-day perishable food items will be purchased when the first resident moves in. Sharp items and knives will be locked underneath the kitchen sink. Facility had back-up emergency food and water supply located in the kitchen cabinet and the garage. Continued on LIC 809-C. Wired smoke and carbon monoxide detectors were tested and operational. All auditory exit alarms were tested and observed to be operational. Fire extinguisher was fully charged, mounted, located in the kitchen, and delivered on August 23, 2025. Stove is a four burner gas stove. There is an oven, dishwasher, refrigerator and freezer. Washer and dryer are located in the garage. All appliances were new and operational. Toxins were locked and inaccessible to residents in a cabinet in the dining room. LPA observed that First-Aid kit had all the required components. Medication cabinet, staff and resident files were observed in the office. Applicant will keep this locked at all times. The backyard had seating areas under shade. There are two exit gates in the backyard, both of which are self-latching. LPA reviewed the Component III with applicant, Polly Valencia. LPA will provide copy of this report to Centralized Applications Bureau (CAB) for review and final application approval will be issued by CAB. LPA conducted an exit interview with Polly Valencia and a copy of this report was reviewed and provided to the facility.