Pre-licensing visit·December 15, 2025

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct the facility's pre-licensing visit. LPA met with Applicant Josephine Guillermo. There are 2 residents present on site. This facility address is currently licensed (43520259) and is under a change of ownership (CHOW). During visit, LPA toured the inside and outside of the facility to include the kitchen, dining, living room, garage,and 5 resident rooms, 1 staff room. The facility had a Ring doorbell at the front door. No bodies of water were observed. Facility temperature maintained at 71 F. Based on the facility fire clearance, the facility is approved for 5 NON-AMBULATORY of which 1 may be BEDRIDDEN in Bedroom #2, which has an exit to the exterior. All exit and passage ways were free and clear of obstruction. LPA observed a nonperishable food supply of 7 days and a perishable food supply of 2 days. LPA observed sharp supplies in a locked drawer in the kitchen. Fire extinguisher was inspected on 5/1/2025. The facility fire protection system was inspected on 9/17/2025 by the local fire department. LPA observed medications locked in a kitchen cabinet inaccessible to residents in care. LPA toured 5 Resident bedrooms. Bedrooms 1, 2 and 3 have an exit doorway leading out to the perimeter. Page 1 of 2 LPA observed 1 Camera in the living room area. Applicant states the camera does not work. No cameras were observed in resident rooms. The following posters observed to include the emergency telephone numbers, personal rights, and facility sketch in the living room area. LPA toured the garage area and observed a washer, and a dryer. LPA also observed toxins secured in locked cabinets. LPA observed the facility garage as locked and inaccessible to residents. The facility garage is OFF LIMITS and is not to be used as a habitual (living) space for residents or staff. Applicant stated understanding and that no staff or residents will use the garage as a habitual space. LPA toured 3 resident bathrooms and observed the bathrooms to have functioning lights, covered trash bins, and hand soap. LPA measured water temperature with a range from 110.8 F to 119.8 F. Monitoring devices are in place, playing an auditory sound when a facility exit door is opened, which can be heard throughout the facility. Areas of corrections were discussed during today's visit with the applicant, which included the facility physical plant. LPA observed the facility to have damaged flooring in the kitchen near the sink, a damaged window sill in Bedroom #4, and damaged closet door tracks and blinds in Bedrooms #4 and 5. Bedroom #5 also had a damaged window screen. In addition, LPA observed 4 loose wooden handrails outside the kitchen sliding door and outside Bedroom #1, and the kitchen screen door to have a large hole near the screen handle. The current licensee needs to address that damaged areas and ensure there are no damaged, loose or broken areas prior to issuing license to new owner. Pre-Licensing is incomplete with corrections/deficiencies to be resolved by 12/22/2025. A follow up Pre-licensure LIC809 will be generated upon resolution of corrections/deficiencies. No deficiencies were cited per California Code of Regulations, Title 22. An exit interview was conducted with Applicant Josephine Guillermo and a copy of this report was provided. Page 2 of 2