Pre-licensing visit·February 19, 2026

On 02/19/2026, at 9:00 AM, Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for purpose of Pre-licensing evaluation. LPA met with Facility applicant Haejin Kim. An initial application to operate a Residential Facility for Elderly (RCFE)was submitted to the Central Applications Bureau (CAB) on for a total capacity of six (6) one(1) bedridden and two(2) hospice residents. Fire clearance was granted on 10/14/2025 for five (5) ambulatory and one(1) bedridden. LPA Singh observed the following: Structure: Facility is a one (1) story house with four (4) bedrooms, two (2) 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 outside at the back of the house to control entire house. Bedrooms: Each client bedrooms accommodate any ambulatory client and one bedroom can accommodate one bedridden resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. Bathrooms: The two (2) 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 residents' bathrooms. ***CONTINUED ON LIC 809-C*** LPA Singh verified water temperature was measured at 110 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. one overflow freezer in the garage as well. There is sufficient storage for perishable food. There was adequate seating for meals for all residents. Laundry room with washer and dryer was in the laundry room. Laundry detergents and cleaning supplies were observed in the laundry room in a locked cabinet. Cleaning products were locked in the garage inaccessible to residents. 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 stor ed 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. General items: One(1) 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 Kitchen cabinet. First Aid kit with required components, and locked area for medication storage was observed in the kitchen cabinet. LPA Singh observed a facility phone and was operational. The phone number designated for the facility is 909-600-7767. There is enough Emergency water supply and the required 72-hour emergency food supply for clients and staffs available at the facility. 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 licensure. Component III was completed on this day as well. An exit interview was conducted, and a copy of this report, LIC809, LIC809C was discussed and provided to Facility Licensee/Applicant Haejin Kim.