Follow-up·September 19, 2025

On 9/19/2025, Licensing Program Analysts, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct a case management continuation visit to continue the pre-licensing inspection initiated on 8/29/2025. LPA initially met with the staff on duty and stated the purpose of today’s visit. The licensee, Cleopatra Gardiner, was informed of the visit and instructed the administrator, Moria Gaunavuo, to be present for this visit. Moria arrived at 12:28pm. Present during this visit were 3 residents with 1 staff on duty. Overview : During the previous visit on 8/29/25, this LPA requested another fire inspection to be conducted due to Bedroom #5 on the facility sketch being approved for a non-ambulatory resident. However, it was noted that Bedroom #5 is currently being used as a staff room. Upon further inspection of the room, LPA observed that it lacked windows and a closet. Additionally, the staff bed barely fits in the room, preventing the door from fully opening. The LPA contacted the Fire Inspector to confirm the accuracy of the STD850 report. Based on the new fire inspection report conducted on 9/15/2025: Bedroom #5 on the facility sketch cannot be used for sleeping purposes as there is no egress/exiting from the bedroom; this room can only be used for storage only. Bedroom #4 on the facility sketch has been approved for staff or 1 ambulatory resident use only; this room is not cleared for non-ambulatory. Bedrooms #1, 2, 3, & 6 on the facility sketch are approved for ambulatory and non-ambulatory residents. {pg.1} The facility administrator, Moria, was instructed to update the facility sketch (LIC999) to designate Room #5 for storage purposes only. Additionally, LPA directed Moria to include the location of the 2 fire doors on the facility sketch. Facility sketch must be submitted by end of business day on 9/19/2025. Additional advisories were provided to switch the numbers on the room doors for #5 and #6 to match those listed on the facility sketch. During this visit, LPA noted that the following issues from the previous inspection have been addressed: The fence on the right side of the facility, which was unstable during the last inspection, has been repaired. The exit door leading to the backyard has been repaired as instructed. The garage has been cleaned and organized. The door knob on the closet housing the water heater has been replaced with a lock. The applicant has completed the pre-licensing component of the application process. LPA Villanueva will notify the Central Application Bureau (CAB). Note that Component III was completed on 8/29/2025. An exit Interview was conducted with Moria, and a copy this report was provided to the facility. {pg.2}