Facility Evaluation Report

At 9:40a.m., Licensing Program Analyst (LPA), Antonia Alvizar-Ettima conducted an announced Pre-Licensing visit to the above facility and met with Administrator. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL).

Fire Clearance was approved on 12/04/2024 for a maximum capacity of six (6) non-ambulatory residents, hospice waiver for two (2) residents age range 60 and over. The purpose of today’s visit is to inspect the facility to ensure that the physical plant is in compliance with rules and regulations of California Code of Regulations, Title 22, Division 6, Chapter 8. The facility is a single-story building in a residential community. The facility has two (2) fully charged fire extinguishers, locate in the entryway and laundry room. Fire extinguishers receipt dated May 02, 2025.

A tour of the physical plant inside and outside was initiated at approximately 10:10a.m., and the following was observed: KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, dish washer, sink, stove and microwave. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked in a drawer in the kitchen and inaccessible to residents. LAUNDRY ROOM: The laundry room is located adjacent to the kitchen. The washer/dryer are new. Laundry supplies are kept inaccessible when not in use in a locked cabinet. BEDROOMS: There are four (4) bedrooms designated for residents to use. Bedroom #1-#2 are shared rooms, bedrooms #3-#4 are private rooms. All resident bedrooms are furnished with bed, chair, nightstand, dresser and required bedding and linen.