D.A. Family Home

Type of visit: Required - 1 Year

On 10/10/2025, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Administrator Paula Lovely. LPA explained the purpose of today’s visit. The facility is a one-story RCFE residence, licensed for (3) non-ambulatory and (1) bedridden resident ages 60 and up. The facility consists of (2) resident bedrooms, (1) bathroom, (1) living room, (1) dining room, (1) kitchen, a laundry room, unattached garage, and one shaded patio area. LPA Watson toured the physical plant with the administrator. There were no bodies of water or obstructions on the premises. Evaluation Report Continues LIC 809-C A total of (2) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents, personal belongings were observed. The Bathroom was found to be within Title 22 regulations and was completely operational with grab bars in the shower, and grab bars by the toilet. LPA inspected (3) the smoke alarms / carbon monoxide detectors. And they were in operable condition. The water temperature measured between: 146.6°F in the Kitchen and 140.9 °F in the Bathroom. LPA Troy Watson observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene products were observed. Sharps objects and cleaning agents were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available on the property premises. The fire extinguisher was charged and operable. The facility currently has no residents so no resident files could be reviewed. The facility currently has two staffed employees, and their files could not be reviewed because no files were on premises. The facility has a locked medicine cabinet to store medication. The first AID kit was checked and contained a certified manual, tweezers, thermometer, tape, gauze and scissors. LPA observed the facility's infection control practices, Plan of Operations, Emergency Disaster Plan and See Something Say Something poster. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the administrator Paula Lovely.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Case Management - Annual Continuation

On 10/10/2025 Licensing Program analyst Troy Watson (LPS)made an unannounced case management visit and met with the administrator Paula Lovely and the purpose of this visit is to edit the LIC809-D PAGE created under the required annual inspection. Deficiencies are being cited according to California code of regulations, see LIC809-D PAGE. During the annual inspection LPA Watson was unable to view and access the personnel records. During facility tour LPA measured water temperature at 146.6 degrees F. Because of time constraints this investigation needs further time to complete. An exit interview was conducted with the administrator Paula Lovely and a copy of this report along with the appeals page was given to the administrator.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Prelicensing

On August 29, 2024 at 10:00am, Licensing Program Analyst (LPA), Deborah Lee conducted an announced visit to the facility for the purpose of conducting a pre-licensing evaluation. An application was submitted to CCLD on 3/13/2024 for opening a new facility for a Residential Care Facility for the Elderly (RCFE) to serve residents 60 and over. 3 Non-ambulatory, 1 may be bedridden. LPA met with Rodrick Barnett, Applicant Paula Lovely Administrator and explained the purpose of today’s visit and together toured the physical plant(inside and outside). Overview of Facility: Facility is a single story home located in a residential neighborhood. Property sit in back of a triplex property. There are resident bedrooms, 1 bathrooms, living/dinning room combo, laundry room located off of the kitchen area. There is a detached garage for storage space. The client bedrooms easily accommodate the client's furnishings. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Living room is fully furnished with 1 sofa and 2 chairs, 4 seated dinning table, and mounted TV. Bedrooms Residents: Bedroom #1 have working lights, new blinds and working windows with bars that has an operable release device and will be occupied by 1 residents. Page 1 of 2 Bedrooms Residents: Bedrooms# 2 have working lights and adequate bedding. This room will be a shared room. Bathrooms: Bathroom is located off of the living room area and has a working toilet, wash basins and shower, LPAs observed it to be clean, safe, and sanitary. Linens & Hygiene Supplies: Are located in the a cabinet in the laundry room. Has adequated linens and hygiene supplies. Facility has a lanline phone for emergencies. Fire Extinguisher is fully functioning/charged and is located in Kitchen by the stove. LPA observed all required post. LPA observed an area where centrally stored medications will be kept. It is locked and will be inaccessible to residents. LPA observed a first aid kit with required items Smoke Detectors: Facility has 3 smoke detectors/carbon monoxide detectors. Tested and operable at time of visit. Appliances: LPA observed all kitchen appliances and washer and dryer in working order. The residence is equipped with heat and air conditioning. All toxin will be locket and inaccessible to resident. Water temperature tested at 110 degrees F. All staff files will be locked in a cabinet located in laundry area. Component III: Conducted during today’s Pre-Licensing visit. No corrections needed at this time. An exit interview was conducted, and a copy of this report has been furnished to the applicant. Page 2 of 2the state’s words, verbatim · CDSS document, Aug 29, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 3 Census (if any clients in care): 0 COMP II Participants: Barnett, Rodrick; Lovely, Paula - Applicant/Administrator Interview Method: Telephone interview On 05/23/2024, 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, May 23, 2024