Pre-licensing visit·February 17, 2026

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 1:20 PM, LPA met with Licensee/Administrator Jamie Fides Lao. An initial application to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 7/28/2025 for a total capacity of six (6) non-ambulatory and one (1) bedridden residents. Fire clearance was granted on 09/24/2025. LPA Delgado observed the following: Structure: Facility was a one-story house with five (5) resident bedrooms, two (2) resident bathrooms, living room, dining area, Live-in Staff (2) room (bedroom #6) and kitchen. There was an attached two car garage in the front of the house. No care shall be provided in the garage per Fire clearance. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the front of the house. Bedrooms: Each resident bedroom #1 shared, #3, #4 and #5 will accommodate any non-ambulatory resident, bedroom #2 will accommodate bedridden resident. 5 resident bedrooms were adequately furnished with bed-1 mattress soiled, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: Two (2) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. At 2:35 PM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 109.5 degrees Fahrenheit. (Continued on LIC809C Page 2) (Continued from LIC809 Page 1) 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 home. Laundry detergents and cleaning supplies were observed in locked cabinet away from residents. Living/Family room: There was a living room with seating for all clients and TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence and hygiene supplies stored in a cabinet by the laundry room . Yards/Outside: Patio table and chairs were observed in the backyard. There was a gate on the South side of the property with a self-latching handle. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway. Ombudsman poster and Let-Us-No poster observed. General items: Two (2) fire extinguisher were charged and located in the kitchen and hallway. Ten (10) 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 Medication closet. 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 food and water supply was not observed. Component III has not been completed. Infection Control plan provided. (Continued on LIC 809 Page 3) (Continued from LIC809C Page 2) Pre-Licensing is incomplete and the following corrections to be resolved by 3/10/2026: obtain a separate 72-hour emergency food supply obtain separate emergency water obtain and post visiting policy obtain PPE supplies obtain First Aid Manual (latest edition) obtain emergency lightning obtain paper towel stands obtain new mattress for Bedroom #4 obtain night light for hallway Update sketch to reflect live-in staff quarters and separate staff restroom An exit interview was conducted with Jamie Lao and a copy of this report was given.