Pre-licensing visit·December 4, 2025

At approximately 9:40 AM, Licensing Program Analyst (LPA) Star Stevenson arrived ANNOUNCED to conduct a Pre-licensing Facility Inspection with applicant. Facility has received fire clearance for six residents including one (1) bedridden resident in room #4 and 5 non-ambulatory residents. Bedroom #1 by front door is approved from staff or only an ambulatory resident. Facility is a single-story home with 4 bedrooms and 3 bathrooms. There are 5 small steps without railing to enter the house that present a tripping hazard and applicant has been asked to provide for a ramp or railing that meets code. Applicant will need to provide for separate locked storage outside of locking pantry. In addition applicant will need to provide for a secure area for sharps/knives, LPA recommends a locking drawer or keypad closet. Water delivered from facets accessible by residents measured 133F and not in the 105-120F range as required by title 22 regulations. Applicant is asked to submit a water temp log over 5 days to LPA. Each of the three showers and bathtub will need grab bars installed and each of three toilets will need grab bars install at their sides. The right sink in master bathroom will need to repaired to avoid leaks. Applicant was advised to provide for locking bathroom cabinets if they intend on keeping cleaning supplies in each bathroom. In addition, applicant will need to provide proof of increased lighting in hallway bathroom to serve elderly residents who my have eyesight difficulties. Medications stored above the refrigerator in unlocked cabinets will need to be locked and made more easily accessible. Kitchen appliances, utensils, and food preparation areas are in good condition. Applicant will need to provide for a seven day supply of non-perishable food, as well as two days of perishable foods once residents received. Continued on LIC809C Continued from LIC80 9 Facility has two fire extinguishers, one in the kitchen and the other in hallway were found fully charged and last serviced June 2025. Smoke and carbon monoxide detectors are hardwired and in working order. Windows, doors, walls, ceilings, screens, paint, and furniture are in good condition. On the outside of the home, Applicant was asked to remove lock securing perimeter gate and applicant will need to fill in large in-ground jacuzzi or provide for secure fencing around the body of water. Applicant will need to provide evidence of a larger first-aid kit that contains an American Red Cross 1st Aid manual, as well as, evidence of working dedicated facility phone and internet/video conferencing capabilities for residents in care. Applicant will need to provide photographic or in-person proof of the following to move forward in the licensing process , applicant agrees to complete the following items by January 4th, 2026. A ramp or railing to make 5 small entryway steps less of a tripping hazard. Evidence of a standing grab bars in each of 3 showers and at bathroom tub in master bathroom. Evidence of solid grab bars at each of the 3 facility toilets. Evidence of outdoor jacuzzi filled in with concrete or other substrate or with perimeter fence. Evidence of required posters (Personal Rights, Non-Discrimination, Complaint/Ombudsman posters) See PUB 475 available at www.ccld.ca.gov (minimum dimension of 20"x26") Evidence of locking sharps/knives storage, locking laundry/toxin storage Evidence of night lights in common hallways leading to bathrooms Evidence of dedicated facility phone (phone bill or working phone number) Evidence of first aid kit that includes 1st aid manual approved by American Red Cross Evidence of repair of right master bathroom sink leak. Applicant to submit a 5 day water temperature log to ensure water is between 105-120F. Continued on LIC809C Continued from LIC809C Applicant could not provide evidence of Liability insurance at the time of this visit. Applicant will provide evidence of liability insurance to LPA by 01/04/2026. Upon receipt of repairs and updates, LPA will notify Central Application Bureau to issue license. Signature of Applicant acknowledges understanding