Pre-licensing visit·September 4, 2025

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 1:03 PM, LPA met with Licensee Tywan Towers and current Administrator Favie Jimeno . An initial application for Change of Ownership to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 11/09/2024 for a total capacity of six (6) non-ambulatory, of which one (1) bedridden resident. Waiver/Granted for Hospice Care for six (6). Fire clearance was granted on 2/19/2025. LPA Delgado observed the following: Structure: Facility was a one-story house with four (4) resident bedrooms, two (2) resident bathrooms, living room, dining area, kitchen, office, storage and two (2) staff rooms. There will be live-in staff on premises. There was an attached two car garage in the front of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Each resident bedroom #1-private bedridden, #2-shared non-amb, #3-shared non-amb and #4-private non-amb will accommodate any non-ambulatory resident. Four (4) resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: The two (2) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. (CONTINUED ON LIC 809C) (Continued from Page 1) At 2:15 PM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 116 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked cabinet located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the garage. Laundry detergents and cleaning supplies were observed in garage away from residents. Living/Family room: There was a living/family room with seating for all clients and TV. Linens and Hygiene Supplies: An adequate supply of linens stored in the main hallway and hygiene supplies was stored in a cabinet near the kitchen area. Yards/Outside: Patio table, chairs and covered patio were observed in the backyard. There was a gate on the West and East sides of the property with a manual latch. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway and residents bedrooms. Obudsman poster and Let-Us-No poster observed. General items: Two (2) fire extinguishers were charged and located in the kitchen and hallway. Eight (8) smoke detectors and two (2) carbon monoxide alarms were tested and were observed to be in working order. Client records will be stored in a locked cabinet in the office. First Aid kit with required components, and locked area for medication storage was observed. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water and food supply was observed. No bodies of water observed and no firearms stored at the home. Component III was completed on 04/30/2025 at Riverside RO. (Continued on Page 3) (Continued from Page 2) Pre-Licensing is incomplete and the following corrections to be resolved by 9/18/2025: kitchen floors need deep cleaning and sanitation discern emergency food from regular food supply obtain night light for common bathrooms obtain current edition for First Aid manual obtain additional emergency lightning obtain pest control for ants in kitchen area obtain additional emergency water remove two chains on hooks inside office entry An exit interview was conducted with Tywan Towers and a copy of this report was given.