Kingston Care Living

Type of visit: Prelicensing

On January 23, 2026, 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, for opening a Residential Care Facility for the Elderly (RCFE). Fire clearance approved for capacity of 6 residents 60 and over residents (5 non-ambulatory and 1 bedridden) on July 21, 2025. LPA met with Amirmohammad Alkabir, Applicant and the designee Kashari Jones and explained the purpose of today’s visit. LPA and Applicant toured the physical plant (inside and outside). Overview of Facility: Facility is a 3-story building with the first-floor serve as an RCFE. The other floors are not yet licensed as they are empty. Currently the RCFE has a total of 6 resident rooms all private with private bathroom. The bedrooms are spacious and easily accommodate the residents' furnishings. LPA observed that there are no bodies of water on the premises. The RCFE consists of an activity room, a recreation room, salon room, staff room, family meeting room and Administrator office. Page 1 of 3 The shaded area and outdoor passageways, walkways, driveways, steps and patios are free from obstruction. 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. Resident Bedrooms: Bedrooms 1-6 have working lights, working windows with no bars. All private rooms. The Bedridden room has an exit door leading to the back yard. Bathrooms: All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPA observed adequate lighting throughout the entire facility. Linens & Hygiene Supplies: Extra linens are available to residents when needed and located in each of the residents bathrooms. Living/common room is fully furnished with 6 recliners, projection TV, Dining area is equipped with a 8 seated dinette set. There is adequate space for the residents. Kitchen is clean and sanitary with appliances that are operational. LPA observed 7-day supply of non-perishables foods and 2-day supply of perishable food. LPA observed the area where sharp objects and cleaning solutions will be locked and inaccessible to the residents in care. Stackable washer and dryer located hallway. The Facility has a lan-line phone for emergencies. There are 3 fully charged fire Extinguishers inside the facility. LPA observed all required postings: See something say something, resident rights, emergency disaster plan, facility sketch and exit signs Page 2 of 3 Resident/Staff files: LPA observed that there is a confidential storage area where staff and resident files will be kept it will be securely locked in a file cabinet. Medications: LPA observed that there is a locked centralized area where residents' medications will be stored. Located in locked cabinet near kitchen area. Smoke Detectors: Facility has 20 smoke detectors/carbon monoxide detectors which are hardwired and interconnected. They were tested and operable. Water Temperature: Tested between 105-120 degrees F. There are no corrections needed. Component III: Conducted during today’s Pre-Licensing visit. LPA provide copy of report to applicant. Page 3 of 3the state’s words, verbatim · CDSS document, Jan 23, 2026

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, Jan 13, 2026