With the assistance of the administrator, a tour of the physical plant was initiated, and the following was observed:

The facility is a rental, converted additional dwelling unit (ADU), with it's own separate address. LPA was provided copies of the dwelling conversion permits. The Licensee/Administrator lives at the front house, there is a shared backyard. The required posting were posted by the entry door, accessible to residents. The smoke and carbon monoxide detectors are dual and inter-connected. At 10:38am, smoke/carbon monoxide detectors were tested and observed to be functional. Facility is equipped with two (2) fire doors, one for bedroom#1 and one door leading to bedrooms #2 and #3. During the smoke/carbon monoxide testing, LPA observed both fire doors closing properly. The facility has a brand new fire extinguisher in the kitchen with purchase date of 08/10/2025.

KITCHEN: The kitchen is equipped with brand new appliances, including a refrigerator, stove/oven, and coffee maker. Knives were observed locked in a kitchen drawer. There was an adequate supply of perishable food items in the refrigerator and a supply of dishes in kitchen cabinets. Non-perishable food items are not required at this time, as there are no residents. Administrator was advised that facility needs to carry perishable and non-perishable food items once they admit residents in care. There is a brand new washer and dryer in the kitchen with locked cabinets to store laundry and kitchen detergents and chemicals.

Continued on 809-C

• 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.

BATHROOMS: The facility has one (1) full bathroom, next to the bedrooms #2 and #3. The bathroom was observed to have proper fixtures, grab bars, and non-skid mat. The hot water delivered in the bathroom measured at 117.7 degrees Fahrenheit.

COMMON AREAS: The facility has an open concept living and dining area, right next to the kitchen. Living/dining areas are furnished with couches, table, chairs and television. Facility has land line telephone, internet and wi-fi access for resident's use.

OFFICE/MEDICAL AREA: Facility's office area is located on one corner of the kitchen with locked cabinet to store resident and staff records. Medications and medication reports will be kept locked in kitchen cabinets. There is a complete first aid kit and first aid manual in the medication cabinet.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of any obstruction. The facility shares a backyard with the front house, but has it's own separate entrance and address; there is no separate walls or gates to separate the backyard. The backyard is large enough to hold outdoor activities. LPA observed two sets of patio furniture with umbrellas. There is a fenced and locked swimming pool with jacuzzi and a locked storage shed. There is no garage, since it was converted to an ADU. Facility has several exit doors in bedrooms 1 and 3 and living room, leading to the backyard. There are clearly marked exit signs on top on all the exits doors. Facility uses the main entrance as the emergency exit. All exit doors have functional auditory alerts upon opening.

In addition to the Pre-Licensing inspection, a Component III power point presentation was held.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report was provided to the administrator.