Pre-licensing visit·January 12, 2026

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at facility was greeted and granted entry. LPA met with Kathrina Buller, Director/Administrator. An original initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden resident was submitted to CCL on July 7, 2025. Structure: The facility is a one story house with an attached garage with five (5) resident bedrooms, two (2) full bathrooms, a living rooms, a dining room/kitchen. The resident’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large back yard with seating for the residents and an exit walkway on each side of the house. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with four (4) private rooms and one (1) shared room accommodating two residents. Bedroom 1-4 approved for non-ambulatory residents and bedroom 5 approved for a bedridden resident. Door leading to bedrooms is a fire door that closes fully under its own power. Bedrooms Staff: There is no live-in staff. Bathrooms: Facility has two full bathrooms. Bedroom 5 has its own bathroom. All bathrooms have a working toilet, wash basin, walk in shower. Linens & Hygiene Supplies: Adequate supply of linen are stored in the armoire located in bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an Continued on LIC809-C emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested, and found operational. 1 fire extinguishers mounted in kitchen, charged and dated August 25, 2025. Appliances: Gas eight (8) burner stove, two (2) ovens, refrigerator, freezer, microwave, dishwasher, washer, and dryer are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents are stored and locked underneath kitchen sink and in the garage. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 105.9 Fahrenheit degrees in facility bathrooms Medications, First-Aid Kit & Book: Medication is stored in a medication cabinet located in entry way of bedroom hallway. First Aid kit and first aid manual stored with the medication cabinet. Resident & Staff Files : Records will be kept locked with in the medication storage cabinet. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the resident's use, commensurate with the plan of operation. Fire clearance: Was approved on September 9, 2025. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. Applicant was reminded that it is required to notify LPA, within 5 business days of admitting the first client. This notification may be done by phone, email or fax. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.