107209606-11-17-2025-24-AS-KJMC-DNHUW6-20251117145611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107209606
Report Date: 11/17/2025
Date Signed: 11/17/2025 03:06:40 PM

Document Has Been Signed on 11/17/2025 03:06 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, LEILANI		FACILITY TYPE:	740
ADDRESS:	2963 E NORWICH AVE		TELEPHONE:	(925) 922-4561
CITY:	FRESNO	STATE: CA	ZIP CODE:	93726
CAPACITY: 6		CENSUS: 0	DATE:	11/17/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Co-Administrator (CoAdmin) Glenn Bilog;		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE

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An announced Prelicensing - continuation visit was conducted on the date above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Co-Administrator (CoAdmin) Glenn Bilog. LPA greeted CoAdmin & was allowed to proceed with visit.

In addition to items as stated on previous visit 10/14/25 LIC809 it was determined that:

Bedroom #4 does not meet California building standards & requirements to be classified as a "bedroom". This room, while having an exterior door, has no windows to the outside to allow for natural light & for ventilation. This was reviewed & discussed with Admin by telephone. The Admin has decided to reduce facility capacity by the one (1) for room #4 & will use the room as a storeroom, etc., & will not use as a bedroom. May install window in the future. To notify Community Care Licensing (CCL) if & when. - CORRECTED. PAPERWORK SUBMITTED TO CAB TO REDUCE CAPACITY & IDENTIFY ROOM FOR USE OTHER THAN A BEDROOM, I.E., STORAGE, ETC.
Main bathroom (hall bath) entry does not allow sufficient clearance for a walker or wheelchair to gain access to toilet. It also does not allow a 2nd person to be present to provide assistance. Blocked access for residents & for staff due to how door opens inward & insufficient room to maneuver. Door swings in & does not provide adequate room to meet the needs of a non-ambulatory resident w/ physical limitation or need to use mechanical aid. The door does not provide room to close to access toilet, or to exit toilet area. LPA walked this area during initial visit 10/14/25) & demonstrated how even without any mechanical aid that the door as is created an issue of access & access for staff assistance as well. This was reviewed & discussed with Admin by telephone. According to Admin, current door will be removed & replaced with solid door that allows for the mobility, while maintaining privacy, for non-ambulatory residents. - CORRECTED. SUFFICIENT ROOM TO INSTALL SLIDING BARN DOOR ALLOWING FULL ACCESS TO HALL BATHROOM & DOES NOT INTERFERE WITH HALL PASSAGEWAY KEEPING ALL PASSAGEWAYS CLEAR & FREE OF OBSTRUCTION.

Remaining items for review from previous visit 10/14/25:

Living room has adequate lighting. Seating in Living room insufficient to accommodate 6 residents. - CORRECTED. SEATING FOR 6 AVAILABLE.
Facility does not have mattress pads on the premises. - CORRECTED.
Hot water in resident back bathroom tested & measured at 131 degrees F - CORRECTED - TESTED & MEASURED @ 109 DEGREES F.

Toilet & shower area in back bathroom do not have grab bars - INCOMPLETE: GRAB BAR IN MASTER BATH SHOWER REQUIRED. (Toilet corrected).
Side gates are is not self-closing & self-latching. West side gate will not open completely. - INCOMPLETE. WEST SIDE GATE NOT SELF-CLOSING. NOT SELF LATCHING - to make corrections as needed on East gate as well.

Adding from previous visit 10/14/25:

Backyard fencing has exposed pop-out nails in wood & miscellaneous nails on ground. - CORRECTED - IMMEDIATELY EXPOSED METAL BOLTS, 3" SCREWS; ETC. REMOVED.

Exit interview conduced with CoAdmin. CoAdmin agreed to have final corrections made by date below. LPA to be notified prior to or by due date that corrections have been completed & are ready to be inspected.

Component III was conducted during initial visit 10/14/25.

CAB notified of today's visit & pending deficiencies to be resolved by due date.
"Pre-Licensing is incomplete with deficiencies to be resolved by Thursday, November 20, 2025".

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Kelly J. McClurg
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025

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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