Oak Canyon Living

Type of visit: Prelicensing

On October 10, 2025, Licensing Program Analyst (LPA) Manuel Monter, conducted an announced pre-licensing inspection and met with Licensee (LN) Jerica Gonzales and Administrator Dewanne Schofield. The facility is a residential care facility for the Elderly (RCFE). The facility fire clearance is approved for 5 non ambulatory and 1 bedridden. At the time of inspection there are 0 clients observed. LPA and LN toured the facility inside and outside, which included the Living room, kitchen, dining room, two restrooms and three residents bedrooms. The front yard and backyard were inspected. There was no obstruction to block the walkways. LPA observed a jacuzzi located in the side yard adjacent to the family room and 3 care garage. LPA observed facility garage being used as a storage space. LN provided update facility sketch reflecting the hot tube, which is located adjacent to the family room and 3 care garage. LPA toured bedroom #1. LPA observed bedroom #1 has an exit to the backyard, which contains a ramp. LPA also observed bedroom #1's bathroom, has a door exiting to the outdoor patio. LN stated the door exiting to the outdoor patio is not a designated exit. The facility has 3 designated exit routes per LIC 610D (emergency and disaster plan). The exits are free from obstruction. The facility has carbon monoxide and smoke alarm detectors that are strategically placed throughout the building. The facility fire extinguishers are placed strategically in the dinning room. The fire extinguishers were serviced on January 27, 2025. Page 1 Out of 2. The laundry area is located adjacent to bedroom 3 and bathroom 2. The laundry detergents, cleaning supplies and other toxic are locked and can only be accessed by staff. 3 Out of 3 resident bedrooms have adequate lighting, bed frames with mattress, linens, lamps, night stands, drawer dresser storage and closet space that is sufficient to store clients’ personal belongings. 2 Out of 2 bathrooms hot water temperature measured at 118 degrees Fahrenheit. Room temperature is at 76 degree F. Medication closet observed to be locked. First Aid kit was observed inside the medication cabinet, which contained first aid supplies, with manual, tweezers and scissor. Facility kitchen equipment is functioning properly, LPA observed for sharps. LPA reviewed emergency disaster plan and confirmed its completeness. LPA observed cleaning products and chemicals locked an inaccessible to residents in care. Facility bulletin board contain all necessary documents. No issues noted during this Pre-Licensing Inspection. LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Component III orientation was conducted with Licensee Jerica Gonzales and Administrator Dewanne Schofield. This report was reviewed with Licensee Jerica Gonzales and Administrator Dewanne Schofield and a copy of the report was provided. Page 2 Out of 2. END OF REPORTthe state’s words, verbatim · CDSS document, Oct 10, 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, Aug 29, 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, Aug 29, 2025