Pre-licensing visit·May 1, 2026

Licensing Program Analyst (LPA) Rebecca Borunda conducted an announced Pre-Licensing visit. LPA was met by Applicant Charles Bloom and was granted entry into the facility. The purpose of today's visit is to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. This is a change of ownership with residents in care and had a current census of 71 residents. The fire inspection was completed on 12/23/2025 and the facility is approved for a total of 160 residents, of which 128 may be non-ambulatory and 32 may be bedridden. The facility is also approved for delayed egress. During today's visit, LPA toured the facility and inspected a random sampling of resident rooms and bathrooms, common areas, kitchen, and outside space. The facility was found to be clean, safe, and in good repair with no pathway obstructions. Resident bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature in private and common bathrooms were measured within regulatory requirements. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for resident medications and resident and staff paperwork. Fire extinguishers were observed throughout the facility and found to be in compliance. Functioning carbon monoxide detectors and smoke detectors were observed throughout the facility. No bodies of water were observed on the premises. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food. Required postings were observed in a common area of the facility. LPA reviewed the facility’s Infection Control Plan and Emergency Disaster Plan, as well as a random sampling of resident and staff files. Continued on LIC809-C page... LPA conducted Component III with the applicant. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance. Pre-licensing is complete, and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with Applicant Charles Bloom, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).