Bright Skies of Costa Mesa 2

Type of visit: Prelicensing

On July 8, 2026, Licensing Program Analyst (LPA) Edward Kim and Regional Manager (RM) Monica Tran conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Kim and RM Tran met with Applicant Kathrina Buller and toured the facility. An initial application to operate a Residential Care for the Elderly (RCFE) was received by CCL on February 27, 2026. The facility is to have a capacity of five (5) nonambulatory residents and one (1) bedridden resident. The facility has requested a hospice waiver for six (6) residents. Facility phone number (657-232-1469). LPA Kim and RM Tran observed the following. Structure: The facility is a one-story house with an attached 2 car garage with six (6) resident bedrooms, two (2) bathrooms, nook used for office space, dining room, a kitchen, and a living room. There are nine (9) exits: One exit in main entrance, one exit in Resident Room #1, one exit in Resident Room #2, one exit in Resident Room #3, one exit in Resident Room #4, one exit in Resident Room #5, one exit in Resident Room #6, one exit in the nook, and one exit in the living room. Air/Heating: Central air/heating system installed with a central panel to control entire house located in the living room. Temperature was at 73 degrees Fahrenheit. Staff Bedrooms: There is no staff bedroom Evaluation Report Continues on LIC 809-C Resident Bedrooms: There are six (6) Resident Bedrooms: Bedroom #1, Bedroom #2, Bedroom #3, Bedroom #4, Bedroom #5, and Bedroom #6. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings. Bathrooms: All two bathrooms have a working toilet, wash basin, and shower. All bathrooms are clean. Shower mats were in all two bathrooms. Hot water was measured in all bathrooms. Hot water measured between 117.3 degrees Fahrenheit to 118.4 degrees Fahrenheit. Linens & Hygiene Supplies: Adequate supply of linen stored in nook. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed and posted in the hallway near the kitchen. Menus posted and available information in kitchen. Food Service: There is a 2-day perishable food. There is 7-day non-perishable food supply on hand. The emergency food and emergency supplies are locked in the nook cabinets Emergency water are stored in the garage. Toxins: All cleaning supplies and chemicals are kept locked under the kitchen sink and in the garage cabinets next to the laundry area. Sharps are stored safely and locked in a kitchen drawer. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There are two (2) fire extinguishers that are fully charged and were serviced on April 9, 2026 and are mounted in the kitchen and in the garage. Evaluation Report Continues on LIC 809-C. Outdoor/Yard: There are two (2) outdoor areas for residents that are adequate for seating and for shaded areas. There are enough tables and chairs for all residents There is one outdoor gate that is self-closing and self-latching. Medications, First-Aid Kit & Book: The first aid kit and all medications are stored in the nook cabinet. The first aid kit has all the required elements. The cabinet is kept locked. Resident & Staff Files: The Resident and Staff Records will be kept locked in a nook cabinet. Reading Material, Games, Equipment & Materials: Art supplies and activity supplies are stored in the entryway. Each bedroom has individual large screen TV. Appliances: There is one five (5) gas burner stove which lights unassisted, oven, microwave oven, a refrigerator in the kitchen, two (2) refrigerator in the garage, dishwasher, washer, and dryer. All appliances are clean and operational. Fire clearance: Fire Clearance approved by Orange County Fire Authority on April 3, 2026. Component III: Component III waived during the visit as Licensee is currently operating another facility. The pre-licensing visit and Component III Orientation are now complete. The facility meets the requirements for licensure. LPA Kim will forward this report to the Centralized Applications Bureau for review. The license will be granted upon completion of a final review and approval from the Centralized Applications Bureau. Exit interview was conducted and a copy of this report was left with Applicant Kathrina Buller.the state’s words, verbatim · CDSS document, Jul 8, 2026

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Interview Method: Telephone interview On 5/21/2026, applicant/administrator participated in COMP II for the below pending facilities: [Bright Skies of Mission Viejo - 306006913, Bright Skies of Costa Mesa 1- 306006927 & Bright Skies of Costa Mesa 2 - 306006932]. 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, May 21, 2026