Pre-licensing visit·October 31, 2025

On 10/31/2025 at 10:50AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation. LPA met with Administrator, Guillerma Mahinan. An initial application to operate a Residential Care Facility Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 7/11/2025 for a total capacity of four(4) non-ambulatory residents, with a Hospice waiver for four (4). Fire clearance was granted on 06/10/2025. LPA observed the following: Structure : Facility is a house with three (3) resident bedrooms, two (2) resident bathrooms, living room, dining area and kitchen. There was an attached two car garage in the front of the house. Heating /Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house. Bedrooms: All bedrooms are adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, Night light(s) will need to be added in the main hallway leading to shared bathroom. . Bathrooms : Both bathrooms have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 122 degrees Fahrenheit. Administrator will adjust the water heater. Kitchen: The kitchen has an adequate supply of dishes, glasses, utensils and pots and pans. Knives/sharp instruments will be secured in a locked cabinet in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Kitchen: There was sufficient storage for perishable food. There was adequate seating for meals for all residents. Laundry: Laundry room with washer and dryer was located in the garage. Laundry detergents and cleaning supplies will be kept in the garage secured in a locked closet. Living /Family Room: There was a living/family room with a TV and adequate seating for all residents. Linens and Hygiene: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outdoors: There is sufficient covered seating in the backyard. The gate on the left side is the exit and is self-latching. All outdoor pathways were free of obstructions. Emergency Phone Numbers and Exit Plan : Facility sketches were observed posted in the main area close to the kitchen . There was one (1) fire extinguisher(s) and combination carbon monoxide/smoke detectors in resident rooms and in the hallways, which are working and in good condition. General items: Resident records will be stored in a locked cabinet in the dining area. First Aid kit with required components are located in the medication cart. Medication will be locked in the medication cart. LPA observed a facility phone and it was verified to be operational. Emergency water supply and food was observed. An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit and a copy of this report was reviewed and provided to Guillerma Mahinan. . According to Title 22 California Code of Regulations, Licensee/Administrator Guillerma Mahinan has satisfied all of these requirements and is ready for licensure.