Pre-licensing visit·November 24, 2025

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for the purpose of a pre-licensing evaluation. An 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 10, 2025. Structure: The facility is a one story house with an attached garage with 4 resident bedrooms, 2 full bathrooms, a living rooms, a dining room, and a kitchen. The residents’ bedrooms are spacious and will easily accommodate the residents’ furnishings. There is a large backyard with shaded seating, a raised patio with a fireplace, and one exit walkway on each side of the house. Signal system: Central air/heating system installed with a central panel to control the entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with 2 private rooms and 2 shared room accommodating two residents. Bedrooms Staff: No bedroom designated for awake staff. Bathrooms: Facility has 2 full bathrooms. Bedroom 1 has their own bathroom. All bathrooms have a working toilet, wash basin, bath-tub/shower. Linens & Hygiene Supplies: Adequate supply of linen stored in hallway cabinet space. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an 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 Continued on LIC809-C kitchen with surplus goods stored in the kitchen. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested and found operational. Appliances: Gas five-burner stove/single oven was not operational, refrigerator, microwave, 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 in underneath sink and a storage cabinet in the garage. Water Temperature: Tested and recorded the water temperature measures 63.6 Fahrenheit degrees. Medications, First-Aid Kit & Book: Medication will be stored in a locked cabinet located in the bedroom hallway. Resident & Staff Files : Records will be kept locked in a cabinet with the medication. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents use, commensurate with the plan of operation. Fire clearance: Was approved on July 10, 2025. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. Based on the observations made during this visit, the physical plant facility does not meet the requirements of Title 22 Regulations and is not ready for licensure. The following items must be completed prior to licensure: 1. Facility gas needs to be turned on by the gas company. 2. Kitchen stove needs to be operational. 3. Hot water temperature needs to be measured between 105-120 Fahrenheit degrees. 4. Resident bedroom #3 needs closet to be completed with either of the following: a large dresser drawer, hanging rod for clothes, a door for the closet. 5. Outside fireplace to have a cover. Any items noted during today’s visit are to be corrected and the verifications by LPA visit, applicant to advise LPA when it is completed. LPA will conduct a follow up visit to verify all corrections have been made. All corrections need to be completed prior to licensure. Exit interview was conducted and a copy of this report was left with the applicant.