Pre-licensing visit·October 29, 2025

Licensing Program Analyst (LPA) Fred Arias made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with applicant Kathrina Buller. An application to operate an Residential Care Facility for the Elderly (RCFE) was received by our agency on June 30, 2025, for a total capacity of six residents. The fire clearance was approved by a fire inspector from the Costa Mesa Fire Department on September 22, 2025. The facility is a one-story home with five bedrooms, two bathrooms, a living room, a kitchen with a dining area, and an attached garage. Resident bedrooms had the required furnishings. LPA observed all beds had the required linens and blankets. Hot water measured at 115.5 Fahrenheit degrees. Bathrooms were observed to be operational and have a working toilet, wash basin, and shower. A supply of perishable and non-perishable food was observed. Sharps were secured and locked underneath the kitchen sink. Kitchen appliances are operational. There is a phone and internet access for residents. LPA observed the locked cabinet next to the kitchen where the resident medication will be stored, making them inaccessible. LPA observed emergency lighting and a complete first aid kit stored by the kitchen. LPA observed the See Something, Say Something poster (PUB 475) and Personal Rights documentation posted on the wall. LPA observed the backyard to be free of obstructions and debris. LPA observed a shaded seating area in the backyard for resident use. LPA observed the carbon monoxide and smoke detectors to be operational. LPA observed the fire extinguisher fully charged and inspected on September 8 2025. LPA reviewed the Component III presentation with applicant. Continued on LIC 809-C dated 10/29/2025 LPA will provide copy of this report to Centralized Applications Bureau for review and final determination of the application. LPA conducted an exit interview and a copy of this report was provided to the facility.