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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209606
Report Date: 10/14/2025
Date Signed: 10/20/2025 04:42:34 PM

Document Has Been Signed on 10/20/2025 04:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NORWICH ELDER CARE, LLC.FACILITY NUMBER:
107209606
ADMINISTRATOR/
DIRECTOR:		ARAGON, LEILANIFACILITY TYPE:
740
ADDRESS:2963 E NORWICH AVETELEPHONE:
(925) 922-4561
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 6CENSUS: 0DATE:
10/14/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Mgr-Mbr & Administrator (Admin) Leilani "Lani" Aragon; Mgr-Mbr & Co-Administrator (CoAdmin) Glenn Belong;TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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An announced Pre-Licensing/Component III (Pre/CompIII) visit was conducted on the date above by Licensing Program Analysts K. McClurg & M. Vega. LPA's met with Administrator (Admin) Leilani "Lani" Aragon, introduced selves, provided business cards, stated purpose of visit & was allowed entry.
  • Facility telephone number: (559) 319-6988.
  • No bodies of water on the premises, such as pools, spas, fountains, etc.
  • No fireplaces or wood burning stoves on the premises.


Facility Fire Cleared for all Non-Ambulatory with room #4 Fire Cleared for 1 Bedridden.
  • Facility map updated to correctly identify room #4 (bedridden) & show back patio as covered.
  • This facility does not have delayed egress;
  • This facility does not have a secured perimeter;

RE: Hospice Waiver: Admin indicated during this visit that they would like to have a Hospice waiver. Admin agreed to submit Hospice waiver request to Centralized Application Bureau (CAB) immediately, prior to facility being licensed.



(Continued)
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Kelly J. McClurg
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606
VISIT DATE: 10/14/2025
NARRATIVE
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(Continued)

Physical plant toured.

Kitchen, Dining, & Living

  • Kitchen appeared to be clean with appliances at appropriate temperatures. Kitchen area has trash can with a tight fitting lid. Locked area to secure knives & stove knobs & make inaccessible when not in use.
  • Dining room sufficiently furnished with adequate lighting.
  • Living room has adequate lighting. Seating in Living room insufficient to accommodate 6 residents.

Bedrooms & Bathrooms
  • Resident bedrooms sufficiently furnished with adequate lighting
  • Facility does not have mattress pads on the premises.
  • Bathroom fixtures operational & appear to be clean.
  • Hot water in resident back bathroom tested & measured at 131 degrees F.
  • Toilet & shower area in back bathroom do not have grab bars


Facility has dedicated area to secure & maintain resident & staff records as well as medications & medication records.

Operational auditory alarms on all exits. Smoke detectors tested & operational Carbon monoxide detector operational; Interior & exterior passageways free of obstructions.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Kelly J. McClurg
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606
VISIT DATE: 10/14/2025
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(Continued)

Garage & Yard Areas
  • Garage area has laundry equipment that appeared to be clean & in working order. Storage cabinets with ability to lock available to make contents inaccessible.
  • Front & backyard areas appeared to be maintained w/ absence of miscellaneous debris. Side gates are is not self-closing & self-latching. West side gate will not open completely.



"Pre-Licensing is incomplete with deficiencies to be resolved by Monday,October 20, 2025. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies."


Exit interview conducted with Admin. Copy of report provided. CAB notified, prior to end of visit, that inspection has been conducted & ready for review.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Kelly J. McClurg
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC809 (FAS) - (06/04)
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