Beachside Senior Care Home 2

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Nancy Guillen conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An initial application to operate a Residential Care Elderly Facility for six non-ambulatory residents of which one may be bedridden was submitted to CCL on November 7, 2025. LPA met with applicant Kathrina Buller. LPA observed that Administrator Kathrina Buller has a valid Administrator certificate which expires on October 30, 2026. Administrator was background cleared and associated to the facility. The facility received an approved Fire Clearance by Orange County Fire Authority Inspector Christopher Bird on December 10, 2025. The facility is a two -story home with five resident bedrooms, three bathrooms, a kitchen, a dining room, a living room, backyard and attached garage with an exterior entry. LPA accompanied by the applicant, conducted a tour of the physical plant. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the entryway of the facility. LPA inspected the five resident bedrooms. The five bedrooms are clean and free of hazards. LPA observed all the resident bedrooms has the required furnishings of a bed, a chair, and chest of drawers, and a lamp. Resident beds have clean linens and blankets. LPA observed additional linens stored in a cabinet in bathroom #1. Client bathrooms are clean. Bathrooms were equipped with grab bars and non-slip mats. Faucets and toilets were operational. Hot water temperature measured between 110.6 and 112.2 degrees Fahrenheit. LPA observed the facility has an emergency food and water supply and personal protective equipment stored in a hallway cabinet. Continued on LIC 809C LPA observed the facility has board games, books, and other recreational materials for the residents use stored in the living room. The facility has two internet devices for resident use. Resident and staff records are in a shelf in the hallways accessible to residents. LPA advised applicant to place files in a locked area inaccessible to residents or public. LPA observed the kitchen has a minimum two-day perishable and seven-day non-perishable food supply. LPA observed the kitchen to be clean and free of vermin. LPA observed the gas stove, refrigerator, microwave, washer, dryer and dishwasher were all observed to be clean and operational. LPA observed knives to be locked underneath the kitchen sink. Fire extinguishers are located in the dining room and stairway. Fire extinguishers were observed to be charged and serviced as of December 5, 2025. LPA observe the smoke and carbon monoxide detectors were operational. Auditory devices tested operational for all exits. The centrally stored medication is located in a locked hallway cabinet. LPA observed the First Aid Kit had all the required components. The garage is inaccessible to residents and is used as an office space and storage, however the office room is not reflected on the facility sketch and the measurements of the garage are incorrect. LPA informed applicant that the facility sketch must accurately represent the current rooms and their designated uses. Applicant stated a new fire clearance will be conducted. Cleaning supplies are located in hallway closet in between bedroom #5 and the stairs . LPA accompanied by the applicant toured the outside of the facility and observed it to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the exterior of the facility is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. LPA informed applicant evacuation is required due to two-story home. Applicant stated they will purchase an evacuation chair. LPA informed applicant that the corrections and repairs need to be made before approval from the Centralized Application Bureau can be made. Applicant will notify LPA when the corrections and repairs are completed and schedule another pre-licensing visit with LPA. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 06 Census : 0 Method: Telephone call with CAB COMP II Participants: KATHRINA BULLER Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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 19, 2026