Pre-licensing visit·October 28, 2025

On 10/28/2025 at 9:15 AM, Licensing Program Analysts (LPA) Beena Singh conducted an announced visit to the facility for purpose of Pre-licensing evaluation. LPA met with Facility Licensee/Applicant Iftikhar Tajwar. An initial application to operate a Residential Facility for Elderly (RCFE)was submitted to the Central Applications Bureau (CAB) on 04/08/2025 for a total capacity of six (6) non-ambulatory. Fire clearance was granted on 08/05/25. LPA Singh observed the following: Structure: Facility is a one (1) story house with four (4) bedrooms, three (3) bathrooms, living room, dining area and kitchen. There was a two (2) car garage in the right side of the house. Heating/Cooling System: Central heating and air conditioning system installed with one (1) central panel located in the kitchen to control entire house. Bedrooms: Each client bedrooms accommodate any non-ambulatory client. All client bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. Bathrooms: The three (3) bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. LPA tested the water temperature in the clients' bathrooms. ***CONTINUED ON LIC 809-C*** LPA Singh verified water temperature was measured at 115 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the laundry room. Laundry detergents and cleaning supplies were observed in the kitchen in a locked cabinet. Living/Family room: There were two living/family room with adequate seating for all clients and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted near the main entrance. There was Let-Us-No poster, see something say something poster and Labor Laws observed. Hospice waiver was granted on 09/23/2025. General items: Two (2) fire extinguisher were charged and located in the kitchen and hallway. Three (3) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Client records and staff records will be stored in a locked cabinet in the hallway cabinet. First Aid kit with required components, and locked area for medication storage was observed in the hallway cabinet. LPA Singh observed a facility phone and was operational as evidenced by LPA dialing the number. The phone number designated for the facility is 909-320-7465. There is enough Emergency water supply and the required 72-hour emergency food supply for clients and staffs available at the facility. Component III was completed on this day as well. Additionally, LPA Singh observed facility having Visitor Sign In/Sign Out Sheet and Client Sign In/Sign Out Sheet, upon entering facility. 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 clients in care. Facility appears to be ready for license. An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Facility Licensee/Applicant Tajwar Iftikhar.