Pre-licensing visit·April 9, 2025

On 04/09/2025, Licensing Program Analyst (LPA) Becky Mann conducted an announced visit to the facility for purpose of Prelicensing evaluation. LPA met with Administrator Amanda Gonzales. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 09/01/2024 for a total capacity of six (6), six (6) Non-ambulatory. LPA observed the following: Structure: Facility has three (3) bedrooms, one (1) staff room, two (2) bathrooms, living room, dining area and kitchen. There's an attached garage. Bedrooms: Each resident bedrooms accommodate any non-ambulatory resident. All resident bedrooms were furnished with bed, mattresses, chair, closet, linens, adequate lighting and an operable dual smoke and carbon monoxide detectors. Bathrooms: The two (2) resident/staff bathrooms have a working toilet, wash basin, grab bars and shower. LPA verified water temperature was measured between 108 to 111 degrees Fahrenheit. Kitchen/Garage: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. Laundry detergents and cleaning supplies were observed in the garage in a locked cabinet. Living/Family room: There's a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens were stored in the facility. Yards/Outside: Patio furniture for outdoor seating observed. Self-latching handle gate on left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted in the dining area. General items: One (1) fire extinguisher were charged. The smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Resident records and staff records will be stored in a locked cabinet in the kitchen area. First Aid kit with required components and locked area for medication storage was observed. LPA observed a facility phone, and which was operational. There is enough Emergency water supply and the required 72-hour emergency food supply for residents and staff available at the facility. Component III was completed on this day. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of residents in care. Facility is ready for licensure. An exit interview was conducted, and a copy of this report, LIC809 and LIC809C was discussed and provided to Licensee.