Pre-licensing visit·October 27, 2025

On 10/27/25, at 9:00am, Licensing Program Analyst (LPA), Sommer Hayes conducted an announced inspection to the above facility for purpose of a continuation 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. During the last visit the applicant, Monalisa Silapan was given the following list of advisories to correct. Corrected Advisories 10/27/2025 1. Applicant Monalisa Silapan has corrected room #2 to reflect a single room for one resident. This room has been changed into a single occupancy room from a double occupancy room. The room currently has one twin bed, one nightstand, one chair, one lamp and one tall dresser. 2. Bathroom #2 Applicant added a vent cover to missing bathroom vent. 3.Room #4 Extra furniture was removed in this bedroom to avoid bed from blocking exit door. 4. The backyard water hose is properly stored in a water hose stand to avoid tripping hazards. 5. No one is living in the home at this time. Personal items have been removed from the home. Cont'd on 809C 6. Since the last inspection on October 10, 2025, applicant Monalisa Silapan has obtained a valid permit for the installation of the “drywall to make partitions between 2 bedrooms” has been permitted by the City of Elk Grove on October 17, 2025. 7. Applicant completed appropriate tags and inspections for both fire extinguishers to make sure they are properly charged and ready for today’s inspection. Both fire extinguishers were tagged and inspected by Cintas on October 17, 2025. Pre-licensing is not complete at this time pending an updated fire clearance, changing the capacity from 6 to 5 residents. LPA Hayes will return at a later date to complete inspection once this has been completed. 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.