Pre-licensing visit·October 10, 2025

On 10/10/25, at 11:00am, Licensing Program Analyst (LPA), Sommer Hayes conducted an announced inspection to the above facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on 2/19/25, for an Initial license for a Residential Care Facility for the Elderly (RCFE). The requested capacity is for 6 non-ambulatory residents. LPA was greeted and accompanied on inspection by the applicant, Monalisa Silapan and Nina Menez. This home is a single-story house located in a residential neighborhood. The home has 4 bedrooms. Bedroom #1 is currently a double occupancy bedroom with a master bath and cleared for non-ambulatory residents. Bedroom # 2 is currently a double occupancy for residents and cleared for non-ambulatory. Bedroom # 3 is a single occupancy room cleared for a non-ambulatory resident. Bedroom # 4 is a single occupancy room cleared for a non-ambulatory resident. There is a total of 2 bathrooms. Resident bedrooms are located on the left and right sides of the house. In the outdoor area there was a sun room leading to the backyard, a covered patio with outdoor furniture, fruit trees and a Zen Garden. Outdoor passageways, walkways, driveways, and steps are free from obstructions. Fence and gates are in good repair. No swimming pools/bodies of water at this time. {Con't on LIC809-C} There is 1 refrigerator in the kitchen. Washer and dryer are located in a locked laundry room. First aid kits were inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and manual which are stored in locked cabinet in the kitchen area, available for staff use but inaccessible to residents. Centrally stored medications will be locked in two cabinets in kitchen. Pre-licensing is not complete at this time. LPA Hayes will return at another time when the following advisories are completed by the applicant, Monalisa Silapan. Room #2 is approved by the Cosumnes Fire for a non-ambulatory room but is not approved by LPA Hayes for two non-ambulatory residents. This room is not appropriate for two non-ambulatory residents, two dressers, two night stands and two chairs and any assistive devices. There is not enough space to safely accommodate two residents in this space. Applicant Monalisa Silapan has agreed to change this room into a single occupancy room from a double occupancy room. Bathroom #2 Applicant will add vent cover to missing bathroom vent. Room #4 Remove extra furniture in this bedroom to avoid bed from blocking exit door. Make sure backyard water hose is properly stored to avoid tripping hazards. Make sure there is no one living in the house. Personal items need to be removed from the house before the next inspection. Applicant Monalisa Silapan will follow up with River City Fire to add appropriate tags and inspections for both fire extinguishers to make sure they are properly charged and ready for the next inspection. Based on a review of this home during this Pre-licensing visit, it was determined that this facility was found not to be in compliance at this time. LPA Hayes will coordinate an announced visit with applicant, Monalisa Silapan. LPA Hayes will notify the Central Application Bureau (CAB) that the pre-licensing and Component III has not been completed and not passed. An exit interview was conducted, and a copy of this report has been provided to the applicant Monalisa Silapan.