Facility-requested visit·February 6, 2026

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an announced Case Management visit to the facility. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Co-Administrator Jennifer Fernandez. The purpose of today's visit was for LPA to conduct a walk-through of the facility at the request of Co-Administrator Fernandez and provide consultation on best practices and licensing resources prior to the facility beginning to accept new residents. The facility has not had any residents since the end of March 2025. During today's visit, LPA and Co-Administrator Fernandez toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility is prepared to contain at least two (2) days of perishable food, and at least seven (7) days non-perishable food. Co-Administrator Fernandez showed LPA the locked cabinet designated for storage of knives and other sharp objects. No pools or bodies of water exist on the premises. Per Co-Administrator Fernandez, no firearms or ammunition are kept at or planned to be kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [Continued on LIC 809-C] [Continued from LIC 809] While touring the side of the home containing bedrooms #4 and #5, LPA noted that the wall that created a hallway to access the two (2) rooms had been removed, thus increasing the size of the rooms. Additionally, the hall closet had been converted into a restroom. A door was placed in between the two rooms, however, per regulation 87307(a)(2)(C), resident rooms may not be used as access ways into another bedroom. This changes route access to bedroom #5, making it only accessible through the exterior door into the room from the yard, or through the garage into bedroom #5's private restroom. Per Co-Administer Fernandez, the route into room #5 through garage access was always what was used, and the previous hallway had not been, hence the removal of the hallway. While the Licensee had submitted an updated facility sketch to the Department on January 5th, 2026 notating the changes to the floor plan, the Department had not received notification from the Licensee regarding proposed construction/alterations or applicable permits for changes to the home. Such modifications to the facility may be subject to inspection by the local Fire Authority. Though there are not any current residents in the home, a Type A citation is being issued for unapproved alterations and are noted on the attached LIC 809-D page. Additionally, as this is a violation pertaining to Fire Clearance Violations, a Zero-Tolerance Civil Penalty is being assessed in the amount of $500 and is noted in the attached LIC 421IM. An exit interview was conducted with Co-Administrator Fernandez to whom a copy of this report, the LIC 421IM, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.