Pre-licensing visit·October 2, 2025

At approximately 9:00 AM, Licensing Program Analyst (LPA) Robert Frank arrived announced to conduct a Pre-Licensing Inspection and met with Applicant, Grace Larcena. Facility has applied to be licensed as a Residential Care Facility for the Elderly (RCFE). Upon arrival, LPA was informed that there were currently no residents in care. Facility has an approved fire clearance dated 03/12/2025 that allows for a total capacity of six (6) Residents, where two (2) can be ambulatory and four (4) can be non-ambulatory. The facility has a Dementia Care Program on file. The facility has an approved hospice waiver for six (6) residents At approximately 9:25 AM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was at a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. Applicant had non-slip mats and grab bars in place. LPA observed a supply of clean linens, hygiene products, and paper products available for residents. Residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. LPA observed dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Applicant agrees to keep keys to these locked areas in facility safe, secured and inaccessible to residents in care. Licensee agrees to maintain at least seven (7) days of perishable foods and 72 hours worth of non-perishable foods and an emergency water supply in case a "shelter in Place" order is given. The required posters were observed hanging in the main entrance area. Continued on 809-C... ...Continued from 809 Facility has sufficient items for cooking and eating. Staff and resident files, and resident medications will be located in the locked cabinet in the kitchen. LPA observed multiple binders for residents and staff records as well as individual bins for storing medications. Facility has indoor/outdoor areas for visiting and activities. Facility's two (2) fire extinguishers were last inspected in 2/2025 and were observed to be fully charged. Facility's combination smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit were sufficient. During walk through, LPA and Applicant discussed the following item: reversing the lock on the garage door or otherwise securing the garage area. Applicant will submit proof of liability insurance once facility has been licensed . LPA observed a facility sketch which accurately reflects the floor plan. Component III orientation was conducted at facility with Grace Larcena. Grace Larcena’s Administrator Certification 6069070740 is current with an expiration date of 5/7/2027. No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as a Residential Care Facility for the Elderly (RCFE). LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. Copy of report discussed and provided to Applicant/Administrator Larcena. Signature on form confirms receipt of document.