Pre-licensing visit·April 8, 2026

On 04/08/2026, Licensing program Analyst (LPA) Jaime Vado conducted an announced prelicensing inspection visit. LPA met with Administrator/Licensee Sopiha Chen and explained the purpose of today’s visit. Currently there are 6 residents and 3 staff present. One of which is the administrator. This is a single level facility with 7 bedrooms, 6 are for residents, and one are for staff. There is a storage located above the garage. LPA observed this room and it is not being lived in and did not see any indications of anyone living in the space. The facility is licensed for age 60 and over. All may be non-ambulatory. With a hospice waiver for 4 residents. At this time there is 1 resident under hospice care. LPA Vado toured the facility both inside and outside. All outdoor and indoor passageway are free and clear of obstructions for emergency exit routes in case of fire or emergency. Facility's ambient temperature is comfortable for residents and LPA. No pools or bodies of water were observed during today's visit on the premises. LPA observed fresh food supplies and emergency one week of nonperishable and two (2) days of perishable foods as in place. Dry goods/can goods are stored in a cabinet located in the garage. Knives are locked in a drawer adjacent to kitchen sink. Toxic chemicals/cleaning supplies are also observed to be locked in the garage of the facility and below the kitchen sink. Both the washer and dryer are observed as functional. There is are an additional drop in freezer in the garage for resident food supplies. There is also a full refrigerator in the garage for residents and staff. Medications are observed to be locked in a hallway closet. Each resident room observed contained the required furniture as outlined in regulations. All resident room also have a half bathroom with exception of bedroom 5, which has a full bathroom with a walk in shower. There is an additional full bathroom that located near the front of the facility adjacent to the kitchen with a walk in shower and shower chairs. Water is tested at 110F in this . Non-skid flooring is present in both walk in showers. Resident bathrooms are observed as clean and in good worker order. Continued on next page... Page 2 All resident room also have a half bathroom with exception of bedroom 5, which has a full bathroom with a walk in shower. There is an additional full bathroom that located near the front of the facility adjacent to the kitchen with a walk in shower and shower chairs. Water is tested at 110F in this . Non-skid flooring is present in both walk in showers. Resident bathrooms are observed as clean and in good worker order. Facility has functioning smoke detectors within the facility as well as carbon monoxide detectors located in the main hallway. Fire extinguishers are observed with inspection dates of 03/06/2025. LPA observed resident linen supplies stored in a hallway closet at the end of the main hallway. LPA inspected the medications and files of 6 residents in care at the facility. Based on review of all resident files, and medications all items are current and logged accurately. 4 staff files are reviewed and they are observed as current. Disaster/fire drill log is reviewed. Disaster drill observed as conducted on 03/06/2026 per training records reviewed. Facility administrator certificate is current expiring 08/15/2027. The following updated forms are requested to be submitted to CCLD by 04/15/2026 : • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC500 Staff Schedule No citations issued. LPA will inform CAB recommending licensure. Report is reviewed with administrator/licensee Sophia Chen and a copy is provided.