Care Connection

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an announced visit to the facility for the purpose of a Pre-licensing inspection. LPA met with Applicant Eric Gilbert. The facility has an approved fire clearance to be licensed to serve six (6) non-ambulatory residents age range 60 and over. All bedrooms are for non-ambulatory residents only. Hospice waiver approved for six (6). LPA and Applicant toured the physical plant interior and exterior. The Pre-Licensing Inspection CARE Tool was used and the following was observed: The facility is a single-story home located in a residential area of Glendora. The home consists of kitchen, dining area, living/activity room, four (4) bedrooms, three (3) bathrooms, laundry room, backyard and detached garage. Appliances such as a microwave and stove were observed to be clean and operating properly. Freezer of adequate size maintained a temperature of 0°F, and refrigerator of adequate size with a temperature of 37° F were observed to be clean and operating properly. Kitchen area was observed to be clean and free of litter, rodents, vermin and insects. Sharps secured in a locked kitchen cabinet, inaccessible to residents. A comfortable, appropriately furnished living/activity room, available to all residents for their relaxation and for entertaining friends and relatives, was observed with games, puzzles and books. Dining area was clean with sufficient seating for six (6) residents. Fireplace in the dining area has a glass door covering. continued on LIC 809C continued from LIC 809 Combination smoke/carbon monoxide detectors located throughout the facility are interconnected, were tested and are operable. There is also a carbon monoxide detector located in the laundry room. Laundry room observed in the hallway included a locked cabinet for detergents. Washing machine and dryer were observed to be in good repair. Three (3) fire extinguishers observed and charged. Residents bedrooms have all require furniture which includes, for each resident, a chair, nightstand, and lights sufficient for reading. Bed linens were clean and in good repair. There is a closet with space for clothing and other belongings. Water temperature was tested and measured within the required 105°-120°F in all three bathrooms. Grab bars were observed in bathrooms used by residents. Slip-resistant flooring was observed in shower floors. Centrally stored medication will be located in a locked kitchen cabinet, inaccessible to residents in care. The first-aid kit was observed and is kept in the kitchen. The kit was missing scissors and a thermometer. Licensee agreed to equip first aid kit with missing items. All outdoor and indoor passageways were clean and free of obstruction. Outdoor activity area that is easily accessible to residents, protected from traffic, and adequate shady area was observed. Doors, exits, hallways, and passageways were clear and free of obstruction. No pools or bodies of water were observed in or around the home. The Pre-licensing is completed. Comp III was not conducted as the Applicant is a licensee and has other facilities. Exit interview was conducted with applicant Eric Gilbert and a copy of this report was provided to Applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Gilbert, Eric On 9/26/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. 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. 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, Sep 26, 2025