Pre-licensing visit·November 18, 2025

Licensing Program Analyst (LPA) Kelly Dulek conducted an announced Pre-Licensing inspection at the facility today and met with Licensee Representative/Applicant Yeny Estrada . Entrance interview conducted . The facility obtained a fire clearance on 10/10/2025 for six (6) non-ambulatory, with a total capacity of 6 (six) residents. The Licensee Representative submitted a hospice waiver request for six (6) residents, which is pending at this time. The facility also has a dementia care plan pending. Component II was completed telephonically with the assigned CAB Analyst on 10/16/2025. Component III was completed during today's visit. The facility is a single-story home in the Ventura area, which consists of six (6) bedrooms and four (4) bathrooms. There is no staff room and Applicant stated that staff will remain awake at night. Beginning at 10:48AM, the LPA, along with Applicant Representative, conducted a physical plant tour to ensure there are no health and safety hazards and the facility is in compliance with regulation. The following was observed: RESIDENT BEDROOMS/BATHROOMS: The resident bedrooms were observed. Two (2) bedrooms are fully furnished for resident use. The resident bathrooms were observed to be clean and sanitary with slip-resistant surfaces. There are two (2) private en-suite restrooms designated for resident use. One (1) private bathroom did not contain grab bars, which Applicant Representative indicated are on order and should arrive later today. There are an additional two (2) shared bathrooms for resident, staff and guest use. Hot water was measured in a sample of resident restrooms and measured within the required range. The facility has a sufficient supply of linens and towels. Facility has a call button system for resident use. Report continued on LIC 809-C Continued from LIC 809 COMMON AREAS: The living room and dining area are furnished appropriately. Paint, windows, window coverings, and floors are in good repair. The LPA observed the required postings in the entry way. Alarms were present on all doors, except the two (2) sliding doors. Common areas maintained a comfortable temperature during the visit. Hardwired combination smoke alarms and carbon monoxide detectors and fire door were tested at 01:12PM and were operational at the time of the visit. Fire extinguishers were observed to be fully charged and Applicant Representative indicated were recently purchased; LPA advised maintaining proof of purchase for fire extinguishers. First aid supplies were reviewed and observed to be in compliance. KITCHEN/FOOD SERVICE AREA: The facility has a sufficient supply of perishable and non-perishable foods. The facility has a sufficient supply of plates, cups and utensils. Knives and sharp items will be stored in a locked drawer. Cleaning supplies and disinfectants will be stored underneath the locked kitchen sink. There is a locked cabinet for medication storage in the kitchen. LAUNDRY/STORAGE AREA: The facility has a laundry area, with locked cabinet for storage of personal care/hygiene items, should any residents be determined at risk with direct access to these items. There is also a storage area, containing emergency food and water and extra supplies. GARAGE: LPA observed the facility has a locked detached garage. Residents and staff will not have access to the locked garage area. OUTDOOR SPACE: Currently, the back and front yards are under construction. Applicant Representative stated the property owner is responsible for completion of the outdoor construction, which was delayed due to recent rain. Currently, paved areas are completed. Applicant Representative stated work to be completed in the yard includes: replacement fencing, installation of turf/landscaping, and gates. Outdoor furniture is pending delivery at this time, which will include seating and shade. All passageways were observed to be free of obstructions. Report Continued on LIC 809-C (p.3) Continued from LIC 809-C The following items must be completed prior to issuing the license: Install grab bars in one (1) private restroom Install auditory alarms on two (2) sliding doors Completion of construction in all outdoor areas to include: landscaping in the front yard, turf/landscaping in the backyard, fence replacement, self-closing & self-latching gate installed to ensure the yard is completely enclosed. 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/LPA. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the report was provided.