Affordable Board and Care Inc. II

Type of visit: Prelicensing

Licensing Program Analyst (LPA) conducted an announced subsequent pre licensing visit at this facility to ensure that the facility is now in compliance with Title 22 Regulations. LPA met with Licensee Representative Vilbert Keshishi. This is a continuation of the pre licensing visit conducted on 10/30/25 wherein the facility lacked the following during the visit: No Laundry and Dryer machines No Gas for water heater and therefore no hot water The telephone is not yet functional Living and Dining Room are not yet furnished Component III was not conducted. At 1:04 PM, LPA conducted physical plant tour and observed the following: The Laundry and Dryer machine were properly installed, tested and observed to be working. The Gas was observed to be working and was tested on the stove and there is now hot water. Bathroom hot water temperature was measured at a range of 110.2°F to 115.8°F The telephone, internet and cable are tested and observed to be all working. Living and dining room furniture were properly set up and observed to be in good repair Component III was waived with the approval of LPM Nichelle Gillyard as Mr. Keshishi is a practicing Residential Care for the Elderly (RCFE) Administrator to his other RCFE facility Affordable Board and Care (197610098) since 2021 (continued on LIC 809-C) (continued from LIC 809) The Facility is now in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. The Licensee Representative was reminded not to accept any resident until he gets the licensure email from CAB or got the physical license in the mail, whichever comes first. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Nov 6, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jose Tan conducted an announced Pre Licensing visit to this facility and met with applicant representative Vilbert Keshishi. The applicant is "Affordable Board and Care II Inc". Fire Clearance dated 09/08/25 was received for six (6) non-ambulatory residents, one (1) of which may be bedridden on room #1. Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. Facility is a single storey home. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The facility dual smoke/carbon monoxide alarm system is hard wired and interconnected. The fire extinguisher is located in the kitchen and was observed to be fully charged and last bought on 09/05/2025. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested and observed to be operational. Hot water was tested in the common bathrooms and was told that the gas is not yet on service so there is no hot water at the facility at this time. The telephone on the premises is not yet functional. An emergency exit plan/sketch is posted on the hallway wall with other posting requirements. There are three (3) resident bedrooms, all shared. There is one (1) additional bedroom and bathroom designated for staff use. Resident bedrooms were observed to be appropriately furnished. The common areas (living room, kitchen and dining areas) were not yet furnished during this visit. Lighting was adequate. Resident and staff records will be stored in a locked kitchen cabinet. Medications will also be stored in the same locked cabinet. (continued on LIC 809-C) (continued from LIC 809) The first aid kit is readily available. There are two (2) bathrooms in the facility. The common bathroom has non-skid mat and appropriate grab bars installed. The kitchen knives are stored in a locked drawer in the kitchen. Kitchen cleaning supplies will be stored in a locked shed located in the backyard. There is no laundry machine and dryer installed during this visit. Laundry detergents, cleaning supplies and other toxins will be stored in the laundry area. The laundry area is located adjacent to the kitchen. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors and locked areas for centrally stored medications. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional. There is a sitting area in the backyard for residents to conduct outdoor activities. The backyard is fenced. The garage was converted as an additional dwelling unit (ADU) with a separate address. There is no body of water in the facility. Component III was not done during this visit. Facility is not in compliance with Title 22 Regulations at this time. The licensee representative was informed that the LPA will come back another day when all the needed correction are done. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 30, 2025

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, Oct 8, 2025

Type of visit: Office

COMP II by CAB successfully completed. 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, Sep 29, 2025