Pre-licensing visit·September 24, 2025

Licensing Program Analyst (LPA) Amy Domingo conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to applicant Adrian Lugo, Administrator. The facility fire clearance was granted on 11/4/24  and reflects that the facility is approved for six (6) ambulatory clients. During today’s visit, LPA, accompanied by the applicant, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Client bedrooms allowed for easy passage and contained the required furnishings. Toilets and showers were in working order. The facility’s ambient internal temperature was 77 degrees F. Water temperature in a client bathroom was 109 F. The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for future client use. Refrigerator temperature was 35 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of medication and confidential client and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Per the applicant, no firearms or ammunition are or will be stored at the facility. (Continue on LIC809C) Continued from LIC809 Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. fire extinguishers and 1 first aid kits were present. Required licensing postings were observed in visible areas of the facility. The items reviewed were compliant with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Adrian Lugo was advised that the facility’s application is pending management final review and approval. An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (3/22) were left with the Administrator, whose signature on this form confirms receipt of these documents.