Pre-licensing visit·October 9, 2025

At 9:30 A.M. Licensing Program Analyst (LPA) Valeria Conway conducted an announced Pre-Licensing Inspection of the above-listed facility. Upon arrival LPA met with Administrator, Harold De Guzman and Back-up Administrator Jocelyn Manacap. Entrance interview conducted. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 10/30/2024. A Fire Clearance was approved for a maximum capacity of six (6), five (5) non-ambulatory residents and one (1) bedridden resident. This facility will be housing residents with dementia. A hospice waiver for two (2) was received. The proposed physical plant is a one (1) story single family dwelling located in a residential neighborhood of Camarillo, CA. There are no residents residing in the facility at the moment. LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. Fire extinguishers are fully charged and recently purchased on 06/30/2025. Fire alarms and separate carbon monoxide detectors were tested at 9:50 A.M. and were functional at the time of the visit. LPA observed all required postings on the facility wall. The Emergency and Disaster Plan will be updated before the first resident is admitted. Continued on LIC 809-C Continued from LIC 809 At 10:00 A.M. a tour of the physical plant was conducted and the following observed: BEDROOMS: The facility consists of a total of four (4) bedrooms. Rooms #1 through #3 are designated as shared resident rooms, and Room #4 is for staff use only. Additionally, Room #1 is equipped with a fire-rated door that will remain closed and is the only room approved to accommodate a bedridden resident. Room #1 also has a direct exit to the outside, equipped with a self-locking and self-latching gate. All bedrooms were equipped and supplied with appropriate furniture including but not limited to a bed, a chair, a night stan, a lamp and a chest of drawers, bedding, and linens. No client bedroom will be used as a public or general passageway to another room, bath, or toilet. There were no visible hazards or discrepancies observed. Inside Room #4, the LPA observed the washer and dryer. BATHROOMS: There are two (2) bathrooms in the house. One is a shared bathroom located in the main hallway for residents, visitors and staff use and another located inside the masted bedroom (Room #1). LPA observed toilets and handwashing stations to be in operation condition. Solid waste containers are in good repair. Hygiene items of general use such as soap, paper towels and toilet paper were observed in each bathroom. Facility provides each resident privacy and personal accommodation. Additionally, bathrooms had slip-resistant mats, and grab bars. Water temperatures were measured in both bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. KITCHEN: Appliances and fixtures appeared clean and functional. At the time of the visit, LPA observed a sufficient amount of dining and cookware, non-perishable and perishable food to accommodate a maximum capacity of six (6) residents and facility staff for seven (7) days. Cleaning supplies and chemicals will be stored in locked cabinets located under the sink. Sharps and knives were observed secured in a locked kitchen drawer positioned to the left of the refrigerator. There were no visible immediate hazards observed. Continued on LIC 809-C Continued from LIC 809-C COMMON AREAS: These include the Family Room, Living Room and Dining Room. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility has a fireplace in the living room. LPA observed the fireplace to be properly screened. There is a designated telephone available and internet service for residents’ use. Facility has enough space to store clean common linen items such as bed sheets, towels, pillowcases, and mattress pads. LPA observed night lights in the main hallway and passages to nonprivate bathrooms. Facility has an auditory signal system in place at the time of the visit. Facility is equipped with two fire-rated doors, one separating all resident rooms from the common areas and another one located in Room #1. These doors are used to enhance safety and prevent the spread of fire. Per the administrator, these doors will be kept closed during business hours. MEDICATION: Medications and complete first aid kit will be stored in a locked closet in the hallway across from Room #3. At the time of the visit LPA observed six (6) individual empty plastic containers where medication will be stored for each resident. Facility will properly document medication on the Centrally Store Medication and Destruction log. SURROUNDING GROUNDS: Garden and yard are easily accessible to residents, and they are sufficient in size, comfortable and appropriately equipped for outdoor use. There was a shaded area with proper furniture for outdoor use. Gate was observed to be self-closing and latching. There are no bodies of water on the premises during today’s visit. LPA observed sufficient space to accommodate both indoor activities and outdoor activities for residents. All outdoor and indoor passageways were observed free of obstruction. Continued on LIC 809-C Continued from LIC 809-C GARAGE: LPA also observed the locked garage, which contains an office equipped with a computer and where all residents’ and staff members’ files will be securely stored to ensure privacy and confidentiality. Furthermore, emergency disaster supplies, locked chemical storage and a sufficient amount of emergency water and emergency food was observed at the time of the visit. COMPONENT III ORIENTATION: A Component III Orientation was conducted with Administrator and Back-up administrator during today's visit. The following needs to be completed/Photos sent to LPA prior to licensure:  No corrections 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. Exit interview conducted. A copy of the Licensing Report was issued.