Everett Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Salvacion Butler, and explained the reason for the visit. At approximately 9:20am, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual and interconnected. The facility has five fire extinguishers. There is one in the kitchen, one in the dining room, one by the garage, and two in the hallway. All five fire extinguishers were charged on December 4, 2025. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food properly stored. Knives were stored in a locked drawer. No cleaning supplies stored in the kitchen. Cleaning supplies stored in the garage. Bedrooms: There are five (5) bedrooms designated for resident use. Bedrooms #2, #3, #4 and #5 are private. Bedroom #1 is shared. Bedroom #1 also has the bedridden fire clearance. LPA observed resident bedrooms to be properly furnished with appropriate beddings and linens with sufficient lighting and closet space. Bathrooms: The facility has three (3) bathrooms. Two bathrooms are designated for resident use. These bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 116 and 119 degrees. LPA did not observe any cleaning supplies, aerosol cans or medications in either bathrooms during the day of the visit. The third bathroom is for staff use only. Common Areas: These included the living room which is equipped with sufficient seating of a couch, recliner, two chairs, television, and a table. There is a fireplace that is properly screened and blocked. Fireplace is non-operational and no tools were present. The dining room table is large enough to accommodate six (6). GARAGE: The garage is attached to the home. Entry is through the side of the house. The garage is used as storage for extra food and cleaning supplies. The garage is inaccessible to the residents. Laundry: Laundry area is located next to the kitchen. Detergents and fabric softeners kept locked in the garage. MEDICATIONS: The medication cabinet is located in the living room. Cabinet is kept locked. Medications and medication records were reviewed for appropriate storage and documentation. There is a complete first aid kit and manual stored inside the medication cabinet. OFFICE/STAFF WORKSTATION: Staff workstation, with computer and printer is located by the living room. Resident Files: Resident files kept locked in cabinet by living room. LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: Staff files also kept in cabinet by living room. LPA conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient space to hold outdoor activities. There is no swimming pool or any other bodies of water. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies were observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Jun 13, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with Administrator Salvacion Butler. A Change in Ownership (CHOW) Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on July 19, 2024. A fire clearance was approved on January 3, 2025, for five (5) non-ambulatory residents and one (1)bedridden resident, for a total capacity of six. The bedridden fire clearance is for room #1. A dementia plan of operation has been submitted. A hospice waiver has been requested for six (6) residents pending the Manager's approval. The smoke alarms and carbon monoxide detector are battery-operated and functional. The facility has multiple fire extinguishers with a service date of 09/05/2024. The fire extinguishers are located in the dining room, kitchen, second hallway area, and by the garage. A tour of the physical plant was initiated at approximately 10:10 am and the following was observed: KITCHEN: The facility has a Kitchen area equipped with a refrigerator, microwave oven, and sink. Adequate supplies of perishable and nonperishable food and dining ware accommodated a maximum capacity of six (6). BEDROOMS: There are five (5) bedrooms designated for residents' use. Bedrooms #2, #3,#4, and #5 are private rooms for non-ambulatory residents. Bedroom#1 is a shared room bedroom with one (1) bedridden resident as per the fire clearance approval. The applicant furnished the resident bedrooms with beds, nightstands, chairs, dressers, bedding, and linen. The bedrooms have sufficient lighting and closet space. (Continue on 809C) BATHROOMS: The facility has two (2) bathrooms for the residents' use. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured 110.3 degrees. No cleaning supplies or hazardous items were present in each bathroom. COMMON AREAS: These included the living room and dining room. The living room was equipped with furniture, a television, tables, and chairs. The dining area has a large dining room table to accommodate six (6). There is a fireplace in the family room. It is screened, and there are no tools. There were no visible immediate hazards. There is a functioning telephone on the premises in the living room. Medications are kept locked in the living room cabinets. There is also an office/workstation area in the living room. LAUNDRY ROOM/GARAGE: The washer is located by the kitchen area, and the dryer is located in the garage. The garage is used as extra storage for non-perishable and emergency food supplies and water. There is another refrigerator in the garage for additional perishable food items. Laundry detergents are kept locked in the garage and inaccessible to residents. Resident Files: LPA conducted a file review of random resident records to ensure compliance with licensing forms. Staff Files: Staff files are also kept in a locked cabinet in the living room. SURROUNDING GROUNDS: The driveway, passageways, and entrance to the home were clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility's backyard has sufficient yard space. In addition to the Pre-Licensing inspection, a Component III power point presentation was also 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 provided.the state’s words, verbatim · CDSS document, Apr 7, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 4 COMP II Participants: Licensee/administrator Salvacion Butler Interview Method: Telephone interview On 3/7/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 7, 2025