Foothill Retirement Care Home

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jose Tan conducted a Pre licensing visit on this date. LPA met with staff Gina Osuna who called the Licensee Representative Evelina Papazyan and explained the reason for the visit. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received on February 07, 2025, the applicant is "Paradise of North Valley, LLC. The application is for a change of ownership. Fire clearance was received on 08/14/2025 for seventy two (72) non-ambulatory residents, forty (40) of which maybe bedridden. 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. At 10:00 AM, physical plant was toured inside and out. The facility's smoke alarms are hard wired and tested regularly every month. Fire inspection was last done on 08/14/25. The facility is also equipped with sprinkler system which was last tested on 03/18/25. Fire extinguishers are located all throughout the facility and were last serviced on 03/04/25. Emergency call system was tested and observed to be functional. The facility has three (3) separate buildings on the same property. First property is the main building consisting, of living/activity room, dining room, kitchen and offices. Second building is called the Cottages which consists of six (6) individual units and the third building is the memory care unit (MCU) which has delayed egress installed on all exit doors, MCU consists of dining room, medication room and beauty shop. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 73°F. The facility is approved for delayed egress and hospice waiver for ten (10) residents. (continued on LIC 809-C) (continued from LIC 809) Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Bedrooms: The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. Hot water was measured in random bathroom at the range of 106.9°F to 119.5°F and observed to be within the required range. Common Areas: These includes the living/activity room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Surrounding Grounds (Outdoors): The property has a covered patio area behind the main building with chairs and additional umbrella covered tables. There is also a covered picnic area in the back of the building. The facility's smoke alarms are hard wired and tested regularly every month. Fire drill was last conducted on 11/05/25. Laundry room is located in a separate structure near the garage. Medications were observed to be stored in designated Medication room in the MCU. The Medication room was observed to be locked at the time of visit. There is a complete set of first aid kit in the Medication room. Resident/Staff File Review: LPA reviewed records of five (5) random residents and six (6) staff. Resident and staff records appeared to be complete and updated. Component III was waived with the approval of LPM Agard as the Administrator Judah Cohen has more than three (3) years of RCFE Administrator experience in another facility. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. Exit interview conducted. Copy of report issued.the state’s words, verbatim · CDSS document, Dec 5, 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 28, 2025