Facility Evaluation Report
Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property at 9:00am and met with Applicant Representative, Donald Brodt. Component II was completed on 01/21/2025. During today's visit, LPA completed Component III with the Applicant Representative.
The applicant has obtained a fire clearance on 12/18/2024 for six (6) bedridden residents approved for bedrooms #1 - #5. The Applicant Representative submitted a hospice waiver request for 6 (six) residents which was approved on 01/19/2025. A dementia care program will be in place.
The facility is a single-story home in the Simi Valley area, which will be licensed as a Residential Care Facility for the Elderly (RCFE). Currently, there are no residents residing in the facility. The facility consists of five (5) bedroom and three (3) bathrooms. There will be a staff room on premises. Main hallway leading to resident bedrooms was observed to be equipped with fire door.
Beginning at 9:07am, the LPA along with the Applicant Representative conducted a physical plant tour to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. THe LPA also inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The following was observed:
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction