Pre-licensing visit·June 5, 2025

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property at 10:00am. Upon arrival, the LPA met with Applicant Representative’s, Analyn Cervantes and Leilani Millera. During today's visit, the LPA completed Component III with the Applicant Representatives. Component II was completed on 04/24/2025. The facility is one story. At approximately 10:10am, a physical plant tour was conducted inside and out. The LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The applicant has obtained fire clearance for a total capacity of six (6) residents, five (5) non-ambulatory residents in bedrooms # 1 - #5 and one (1) bedridden resident in bedroom #2. There are no fire sprinklers in the facility. Main hallway leading to resident bedrooms from the living room was observed to be equipped with a fire door. The smoke alarms and carbon monoxide detectors are wired and function properly when tested. The LPA observed two (2) fire extinguishers fully charged with a date of 08/09/2024. The facility has four (4) private resident bedrooms and one (1) shared resident bedroom. Bedrooms #1, #2, #3, and #5 will be single occupancy and bedroom #4 will be used for double occupancy. Each bedroom is equipped with a bed, nightstands, chests of drawers, chairs and closet space. The beds are furnished with comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. Report Continued on LIC 809C... Report Continued from LIC 809... In addition, no bedroom was used as a passageway to another room, bath or toilet. Bedrooms #2, #4, and #5 have direct access to the outside perimeter. All rooms were free of odors. All window screens were clean and maintained in good repair. There is a closet located in the main hallway that stored an adequate supply of extra bed and bath linens. Facility will have a staff room which will be kept locked and inaccessible to residents. The facility has two (2) bathrooms for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms have sufficient paper products. The LPA observed trash cans with tight fitting lids at the time of the visit. Hot water temperature in both bathrooms measured within the required range of 105 and 120 degrees Fahrenheit. Medications will be stored and locked in a cabinet adjacent to the living room. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual. Facility records will be maintained locked and inaccessible in a file cabinet adjacent to the kitchen. The facility has at least seven (7) day supply of non-perishable food. The kitchen has a sufficient supply of plates, cups, cookware, and utensils. Enough seating for six (6) residents at the same time in the dining room table. Appliances in the kitchen were clean and all appeared functional at the time of the visit. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Kitchen knives and sharps were observed in a locked drawer next to the kitchen sink. Soaps and cleaning supplies will be locked and inaccessible under the kitchen sink. Trash cans had tight fitting lids. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. All window screens and coverings are in good repair. A working telephone is present. There is a television and other entertainment equipment, games and/or activity supplies in the living room. Report Continued on LIC 809C... Report Continued from LIC 809C... There is sufficient space to accommodate both indoor and outdoor activities. Night lights were observed in hallways and bathrooms. There is a fireplace in the living room that was observed to be adequately covered/screened. All doors had functioning auditory alarms at the time of the visit. The facility has required postings, including Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, and Resident Council Rights. No obstructions were observed inside or out. The garage is attached to the house and will be kept inaccessible to residents in care. The washer and dryer was observed inside the garage. Cleaning supplies and personal hygiene items were observed in a locked cabinet at the time of the visit. There is a sufficient supply of emergency food and water. There will be no firearms/ammunition stored on the property. Facility has a generator for emergency purposes. The exterior passageways were clean and clear of any obstructions. There are two (2) self-latching gates for emergency use. The LPA observed the backyard, which has a covered outdoor area and appropriate furniture for outdoor use. The outside area was observed to be large enough to conduct outdoor activities. There are no bodies of water noted at the time of the visit . The physical plant of this facility location is in compliance with Title 22 regulations at this time. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. No corrections needed at this time. Exit interview conducted. The report was reviewed, and a copy was provided.