Cozy Residential Home 2

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to complete a post licensing inspection. Currently there are 5 clients at the facility. Facility was inspected both indoors and outdoors. LPA inspected proposed bedrooms, bathrooms, kitchen, garage, and common areas. Outdoor exits are clear and accessible. There are two floors to this facility. 6 resident bedrooms, and 3 bathrooms were observed. Hot water temperature was measured at 115 degrees. Smoke detectors and carbon monoxide detectors were checked and operational. Fire extinguisher indicator revealed a full charge. Kitchen is clean sanitary, and in good repair. There is a locked areas for cleaning supplies, sharps, medications and toxins. R1, R2 and R3 have conditions that require a higher-level on care. R1 is bedridden, R2 is total care (able to feed self) advisory given and R3 has a restricted health condition requiring an exceptions. This information was confirmed by records reviewed including the physician's report and the discharge papers from hospitals. Advisory given for updating service plans. The following forms and documents were requested to be submitted within 15 days: (1) LIC500 Personnel Report (2) LIC610 Emergency Disaster Plan Per California Code of Regulations, Title 22, deficiencies were observed during this visit. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jul 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jul 7, 2026

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (2) Bedridden persons This requirement is not met as evidenced by: A review of records for Resident #1 (R1) indicated that R1 is both non-ambulatory and bedridden. This was confirmed through interviews with R1. However, it was discovered that R1 is currently housed in Bedroom #1, which does not have fire clearance for a bedridden resident.the state’s words, verbatim · CDSS document, Jul 6, 2026

Plan of correction: The facility will contact the fire department and inform them of the room and resident that is bedridden and will submit information to get a bedridden approval for Room#1 by POC date 7/7/26

From the deficiency page — Deficiency type: Type A · Section cited: CCR87616(a) · Plan of correction due date: Jul 6, 2026

As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means exception as specified. This requirement is not met as evidence by: R3 needs assistance with the Nephrostomy care. Currently there is no plan in place to assist. This poses and immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jul 6, 2026

Plan of correction: Licensee shall submit a written plan to Licensing by the POC date indicated that includes an exception for the resident to remain in place if the facility can demonstrate that they can meet the resident needs. The plan shall include a current care plan

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Albert Johnson arrived announced to conduct a Pre-Licensing Inspection. LPA was allowed entry into the home that will be licensed for a capacity of 4 ambulatory residents. LPA toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed there are no residents at this time. LPA observed the kitchen area, dining area, bedrooms, bathroom, storage areas, and laundry rooms. LPA observed knives/sharps area to be locked. LPA observed required furniture, and lighting throughout the facility. The hot water temperature was measured during this visit. Facility shall maintain the hot water temperature within the required range of 105-120*F. The temperature inside the facility measured at 70*F which is within the required range of 68-85*F. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed centrally stored medications area to be locked. LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s) in the home. Facility has central heating and air. LPA observed the area where the staff and resident files are locked and readily available for review. Component III conducted. Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no violations cited during this visit. Exit interview held, copy of report given.the state’s words, verbatim · CDSS document, Feb 25, 2026

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Jessica Monreal, LLC Member/Administrator Interview Method: Telephone interview On 1/30/26, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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, Jan 30, 2026