Aging in the Bay 4

Type of visit: Prelicensing

At approximately 10:00 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a Pre-Licensing inspection for a Change of Ownership (CHOW) and was greeted by two care staff (S1 and S2) neither of which had Guardian Association to Aging in the Bay 4, but do have Association to a sister facility. Licensee was able to work with Community Care Licensing during today's pre-licensing inspection to get the staff members associated to Aging in the Bay 4. Applicant Charmaine Mendaros was called to advise of today's CHOW inspection who arrived at approximately 10:50 AM to further assist with today's inspection This CHOW is for AWU Home Health LLC. Facility received a fire clearance on 05/27/2026 to care for 6 (six) residents including 5 non-ambulatory and 1 bedridden resident that can be helped in bedroom #1 only as seen on newest facility sketch. The current facility has a hospice clearance for 4 residents. Facility is a Residential Care Facility for the Elderly (RCFE) with 6 (six) Residents in care one of which is currently in the hospital; three residents are receiving hospice care. At approximately 11:15 AM, LPA initiated a tour of the facility with applicant and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens and paper products available to residents. Residents' bedrooms were inspected and observed to have the appropriate furnishings as outlined in Title 22 regulations. Continued on LIC809-C Continued from LIC809 A rear bathroom was noted to have two (2) missing baseboard to the left of the toilet and under the sink that will need to be replaced before the new license is issued. In addition, the backyard fence has damaged boards that will need to replaced to ensure resident safety (for example if a small dog moved in next door) Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a covered seating area in the enclosed front yard with outdoor space for activities. LPA observed locked sheds in the backyard which LPA inspected and observed the contents which consist of tools and extra facility equipment. LPA observed games, puzzles, and activities for residents in care. Facility's fire extinguisher was observed charged and was last serviced February 2026. Smoke and Carbon Monoxide detectors were tested and operational during inspection, as well as, no-smoking signs and oxygen in use signs were posted. LPA reviewed facilities Emergency Disaster and Infection Control plans which were last updated 11/11/2025 At approximately 1:45 PM, LPA reviewed four (4) Staff files, two staff members had to be associated in Guardian from a sister facility during today's pre-licensing inspection and another staff member was missing evidence of 1st Aid training. LPA then reviewed six(6) Resident Files and 6 of 6 had required documentation per title 22 regulations. At approximately 2:00 PM LPA observed facilities Medicine Administration Records (MAR) and both LPA and Licensee observed that five(5) of six (6) Resident MARs were missing evidence of administration of medicines for 07/05/2026. Applicant states facility and residents' families work together to coordinate medical and dental appointments and residents' family coordinate transportation to and from visits. Facility will not does not manage cash resources for residents. Continued on LIC809-C Continued from LIC809-C Component III Orientation was conducted with Applicant Charmaine Mendaros LPA and Applicant discussed the following items: · The need for updated Liability Insurance · Updated Admission Agreements and Care Plans - Applicant understands that they will need to complete new Agreements and Care Plans for all residents once Facility License is approved. · Guardian background clearances and associations - Applicant understands that all current staff members associated to Aging in the Bay 4 (486804180) will need to be transferred and associated to new facility license (486804383) once approved. **Facility will need to repair 4 (four) fence boards and two (2) bathroom base boards In addition facility will need to perform a Plan of Correction for a Type A deficiency by 07/08/2026 BEFORE the new license can be granted. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. Copy of report discussed and provided with Applicant Charmaine Mendaros. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 6, 2026

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.