Pre-licensing visit·October 16, 2025

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an announced Pre-Licensing Inspection . The visit included a Component III orientation and a walk through of the facility's physical plant to evaluate compliance with Title 22, Division 6 of the California Code of Regulations and the California Health and Safety Code . Upon arrival, LPA was greeted at the front entrance by Administrator, Janet Castro and granted entry after properly identifying herself and stating the purpose of the visit. This facility applied to be licensed as a Residential Care Facility for the Elderly (RCFE) . The fire clearance was approved on May 29, 2025, authorizing care for up to five (5) non-ambulatory adult residents and one (1) bedridden in room #1 . Administrator stated she applied for hospice waiver and will follow-up with Centralized Application Bureau Analyst to make sure is added to the license. As of today’s visit, no residents are in care . The submitted facility sketch matched the current physical layout. Facility Inspection LPA, accompanied by Administrator, Janet Castro conducted an inspection of both the interior and exterior areas of the facility. The following observations were made: · The facility was clean, sanitary, and in good repair . · Required postings were displayed in visible locations. · There was sufficient space and equipment to support laundry, visitation, meetings, and resident activities . (continue at LIC809C) (continue from LIC809) · Indoor and outdoor pathways were clear of obstructions and slip hazards. · Smoke and carbon monoxide detectors , emergency lighting , and a facility telephone were operational. · Fire extinguisher was purchased on May 21, 2025 and bore valid inspection tags. · All chemicals and toxic substances were stored in locked areas, inaccessible to residents. Bedrooms and Bathroom · Client bedrooms were equipped with the required furnishings, allowed for easy passage, and had windows with intact screens. · The facility had adequate linens and hygiene supplies available. · Bathrooms (2) were equipped with non-skid mats and grabbars · Toilet, sink, and one shower were fully functional. · The facility's ambient temperature was comfortable and compliant. · Hot water measured at 112°F , within the regulatory range. Kitchen and Storage · The kitchen contained appropriate cooking utensils and equipment . · Knives and other sharp objects were securely stored in a locked cabinet. · A 7-day supply of non-perishable and a 2-day supply of perishable food was stocked upon resident admission. · Medications will be stored in a locked cabinet inside the facility. · A complete first aid kit and manual were available in the medicine cabinet. · Client and staff records will be stored in a locked cabinet. Additional Observations Per Castro, no firearms or ammunition are or will be stored on the premises. Conclusion LPA reviewed and discussed ongoing operational requirements, record keeping, reporting obligations, and physical plant standards with the applicant. All items reviewed were in compliance with applicable regulations. The Pre-Licensing Inspection and Component III orientation were completed during today’s visit. The applicant was advised that the facility is ready for licensure , pending final review and approval by Licensing management . An exit interview was conducted with Castro, during which a copy of this report and the Licensee Appeal Rights (LIC 9058, 03/22) were provided. The signature below confirms receipt of these documents.