Dignity's Place RCFE

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct the Subsequent Pre-Licensing Inspection. LPA met with Administrator (AD) Ryan Stein and Licensee Camalah Kopacz. During this visit, LPA and AD toured the facility inside and out. LPA completed the COMP III with AD and Licensee. The facility phone number will remain the same - (559) 400-8573 The applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.the state’s words, verbatim · CDSS document, Dec 19, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct the Subsequent Pre-Licensing Inspection. LPA met with Administrator (AD) Ryan Stein and Licensee Camalah Kopacz. During this visit, LPA and AD toured the facility. The facility has addressed and corrected the identified issues listed on the initial Pre-Licensing Report dated 10/23/25. This is a Change of Ownership Pre-Licensing. The Currently Licensed facility, Mabuhay Gardens (Lic.107200356) is in process of completing a project in the back yard as part of a CCLD Plan of Correction. Upon completion, LPA Brown will return to complete this inspection and conduct the COMP III. An exit interview was conducted and a copy of this report was left with AD.the state’s words, verbatim · CDSS document, Nov 21, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Katie Brown arrived to conduct the Pre-Licensing Inspecting. LPA met with Camalah Kopacz and Administrator (AD) Ryan Stein. This is a Change of Ownership. LPA began the tour by entering the single story 6-bedroom, 3-bathroom home. This facility has fire clearance for 6 non-ambulatory residents – the Master bedroom and bathroom are designated for care staff. Required postings were hung and visible to all. Common areas throughout the home were well lit with clear walkways and the flooring was intact. LPA observed required supply of, cleaning, disinfecting supplies and paper products. LPA observed resident rooms to find required furniture, bed linens, lighting, towels and personal hygiene/grooming products. The bathrooms are clean, with grab bars and skid resistive mats in good repair. Smoke and Carbon Monoxide detectors were tested and found to be I working order. The Fire Extinguishers were serviced 3/20/25 by Jorgensen Fire Co. The kitchen was observed to have a supply of dishes, plates, utensils, and cooking items. Cleaning supplies, chemicals, sharps and knives are stored and appropriately locked. LPA observed the required food supply, including separate emergency food, water and supplies. Resident medications will be stored in a hallway closet. The First aid kit contained the required items. Doors and passageways are unobstructed throughout the home. Outside of the facility was toured. There is a covered seating area, and a self-releasing gate found to be working properly. The facility phone number is (559) 400-8473. COMP III was not completed today. Page 2 - The following requirements have not been met. AD will correct the identified requirements and contact LPA to schedule a subsequent Pre-Licensing visit: · Kitchen drawer left of oven – fell out upon opening – repair · Master Bathroom – Window caulking replacement, wall cleaning, shower mildew removal, cleaning and re-caulking, sink damage repair or replacement · Main resident bathroom – re-caulking at base of bathtub and shower, baseboard replacement, water damage repair in shower, wall repair at towel bar · Half-Bath – Floor and baseboard replacement · Removal of the dog run (east side of house) Patio table and seating needed An exit interview was conducted and this report was signed by AD. This report was emailed to Camalah Kopacz and Administrator (AD) Ryan Stein.the state’s words, verbatim · CDSS document, Oct 23, 2025

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Sep 11, 2025