Pre-licensing visit·March 24, 2026

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 9:00 AM, LPA met with Licensee Eugene Carson and Administrator Amanda Thomas. An initial application to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 7/9/2025 for a total capacity of six (6) consist of five (5) non-ambulatory and one (1) bedridden residents. Fire clearance was granted on 12/8/2025. LPA Delgado observed the following: Structure: Facility was a two-story house with three (3) resident bedrooms, two (2) resident bathrooms, dining area, family room and kitchen. There was an attached three car garage in the front of the house. 2nd floor consist of two (2) Staff live-in rooms with bathrooms, staff lounge, one (1) bathroom and office accessed by stairs for staff use. One (1) private renter at the time in 2nd floor Master bedroom. Heating/Cooling System: Two separate central heating and air conditioning systems installed with panels located in the hallway on the first floor and second floor. Bedrooms: Each resident bedroom #1-shared, #3-shared will accommodate any non-ambulatory resident, and bedroom #2 will accommodate one (1) bedridden resident and one (1) non-ambulatory resident. Three (3) resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Room #2 & #3 measurements do not match the facility sketch and bedridden room is small for a double occupancy. (Continued on LIC 809C) (Continued from LIC809) Bathrooms: Two (2) resident bathrooms has a working toilet, wash basin, and shower with an inadequate supply of paper towels, adequate supply toilet paper, and soap. At 10:32 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 123.0 degrees Fahrenheit. Shower curtain missing. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, insufficient pots and pans were observed. Knives/sharp instruments were secured in a locked drawer 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 utility area away from residents. Living/Family room: There was a family room with seating for all clients and TV. Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio table and chairs were observed in the backyard with shade. There was a gate on the South side of the property with a self-latching hook. No bodies of water observed and no ammunition will be stored. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway and resident bedrooms that need to be updated. Ombudsman poster and Let-Us-No poster observed. (Continued on LIC809C, Page 3) (Continued from LIC809C, Page 2) General items: Two (2) fire extinguisher were observed and unable to verify charged (no copies of receipts able to view) and located in the kitchen and near the stairs. Eight (8) smoke alarms and two (2) carbon monoxide detectors 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 supply was not observed however the required 72-hour emergency food supply was not discernible from the regular food supply. Component III was completed on March 10, 2026 at the Riverside Regional office. Pre-Licensing is incomplete and the following corrections to be resolved by 4/22/2026: obtain a separate 72-hour emergency food supply obtain separate emergency water obtain PPE supplies obtain copies of receipts for purchase of fire extinguishers obtain First Aid manual (latest edition) obtain ramps for bedroom #2 and back sliding door obtain paper towels with stands obtain trash cans with lids for restrooms obtain and post hot water warnings or reassessed water temperature obtain pots/pans home is cleared of private renter update Facility sketch to reflect changes to 1st floor and 2nd floor with correct room measurements Fire Department to re-assess fire clearance for Bedridden room from #2 to #3 (room is larger) An exit interview was conducted, and a copy of this report was given.