Pre-licensing visit·February 5, 2026

At 9:45 A.M. Licensing Program Analyst (LPA) Valeria Conway conducted an announced Pre-Licensing Inspection to the above listed facility. Upon arrival LPA met with Licensee, Evelyn Stevens. Entrance interview conducted. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 09/26/2025. A Fire Clearance was approved on 12/17/2025, for a total of six (6) non-ambulatory residents only. The proposed physical plant is a one (1) story single family dwelling located in a residential neighborhood of Camarillo, CA. This facility will be housing residents with dementia. This pending facility has a dementia care program and a hospice care waiver for two (2) residents. There are currently no residents being served at the facility. This facility doesn’t have a staff room; facility will provide 24/7 care. At 10:05 A.M. tour of the physical plant was conducted. LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. The following observed: Bedrooms : The facility has two (2) single bedrooms and two (2) shared bedrooms designated for residents use only. There was a model furnished bedroom equipped and supplied with appropriate furniture including but not limited to a bed, a chair, a nightstand, 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. Continued on LIC 809-C Continued from 809-C Bathrooms: There are five (5) bathrooms. Each bedroom has its own bathroom and there is one (1) shared bathroom for visitors and staff. LPA observed grab bars for each toilet, and shower used by residents. All bathrooms were supplied with appropriate paper and hygiene products. Water temperatures were measured in all residents’ bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. Common Areas: These include the Family Room and Dining Room. The common areas were furnished to accommodate a maximum capacity of six (6) residents. Floor surfaces were clean and in good repair. There were no immediate hazards observed. Fire extinguisher was observed fully charged and last purchased on 02/04/2026. Between 10:21 A.M. and 10:24 A.M., hardwired smoke detectors and a separate carbon monoxide detector were tested and were functional at the time of the visit. The facility does not have a fireplace. Cameras are installed in common areas; according to the licensee, the cameras do not record audio. The LPA observed nightlights installed in all hallways and passageways. The facility has an operational auditory alarm system and is equipped with a fire door to enhance safety and prevent the spread of fire. LPA did not observe the required Personal Rights poster, Ombudsman poster, and the Community Care Licensing (CCL) information poster outlining the complaint process. Office Room: LPA observed a desk and file cabinets. Staff and resident files will be stored in this room and maintained in a locked manner to ensure confidentiality. Kitchen: Appliances and fixtures appeared clean and functional. There was sufficient dining and cookware to accommodate a maximum capacity of six (6) residents. Facility doesn’t have many perishable items nor fresh fruit because there are no residents at the time of the visit. Knives and other sharps will be stored in a locked drawer next to the dishwasher. Cleaning supplies, soaps and detergents are locked under-sink cabinets and shall be stored in areas separated from food supplies. There were no visible immediate hazards observed. Community phone and internet access is provided by the licensee to the residents. Continued from LIC 809-C Continued on LIC 809-C Garage/Laundry Area: Inside the garage, the LPA observed a washer and a dryer machine. Staff will assist residents with all laundry needs. Additionally, LPA observed an ample supply of emergency water and dried emergency food at the time of the visit. Surrounding Grounds: Garden and yard are easily accessible to residents, and they are sufficient in size, comfortable and appropriately equipped for outdoor use. Backyard: There was a shaded area with proper furniture for outdoor use. LPA observed one (1) self-closing and latching side gate. There is a locked shed in the backyard that holds gardening tools and extra supplies. LPA observed several gardening beds located in the backyard. LPA advised the licensee that if the gardening beds are used to grow vegetables, the produce shall not be served or provided to residents in care. Medical Area : Medications are stored in a locked kitchen pantry. There is a complete first aid kit inside a kitchen cabinet. Facility will properly document medication on the Centrally Store Medication and Destruction log (LIC 622) once facility receives first resident. Infection Control/Emergency Disaster Planning: The LPA reviewed the facility's infection control plan and the emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Continued on LIC 809-C Continued on LIC 809-C COMPONENT III ORIENTATION: A Component III Orientation was conducted with the Licensee during today's visit. The following needs to be completed/Photos sent to LPA prior to licensure:  Missing curtains in resident’s rooms and living room.  Missing posters 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.