Pre-licensing visit·December 2, 2025

Licensing Program Analyst (LPA) Hanna Gough conducted an announced visit to the facility for the purpose of a pre-licensing inspection. LPA was greeted and granted entry by staff. LPA met with applicant Daryll Avendano, Kelsey Choi and Mark Ryan Cruz. An initial application to operate a Residential Facility for the Elderly for six non-ambulatory residents was submitted to CCL on July 17, 2025. The applicant facility is a one story home with four resident bedrooms, one staff bedroom, three bathrooms, kitchen, living room, dining room and attached two car garage. LPA observed the required departmental postings throughout the facility. The resident bedrooms have all the required components and furnishings with extra storage space for resident use. LPA observed the restrooms to have working toilets, sinks and showers. LPA observed nonslip mats in the showers. LPA tested the water temperature to be 113.3-118.7 degrees Fahrenheit. LPA observed an extra supply of linens for resident use in the hall cabinets. LPA observed the kitchen to be clean and free of vermin. LPA observed a two day perishable and seven day nonperishable food supply on hand. LPA observed the emergency food to be in the kitchen cabinet. LPA observed all appliances to be operational. LPA observed the toxins and chemicals to be in a locked cabinet under the sink. LPA observed the knives and sharps to be in a locked cabinet under the stove. LPA observed the centrally stored medication will be stored in a locked cabinet in the dining room. LPA observed a first aid kit and manual in the cabinet where the medication will be stored. LPA observed the garage to have a room inside that is only cleared to be used as storage on the fire clearance. LPA observed the emergency water to be stored in the garage. Continue on LIC809C LPA observed the washer and dryer in the garage are operational. LPA observed the backyard to be free of debris and obstructions. LPA observed the backyard to have a shaded seating area for resident use. LPA observed the exit gates to be unlocked and operational. LPA and applicant tested the carbon monoxide and smoke detectors and they were found to be operational. The fire clearance was approved on September 4, 2025. LPA conducted the Component Three Orientation with applicant. Applicant was notified that the final application approval will be issued by the Centralized Application Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided at the time of the inspection.