Peaceful Haven

Type of visit: Prelicensing

On August 26, 2026, Licensing Program Analyst (LPA) Edward Kim conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Kim met with Applicant Yama Raawee and toured the facility. An initial application to operate a Residential Care for the Elderly (RCFE) was received by CCL. The facility is to have a capacity of one (1) ambulatory resident and five (5) bedridden resident. The facility has requested a hospice waiver for six (6) residents. Facility phone number (949-315-4232). LPA Kim observed the following. Structure: The facility is a one-story house with an attached 2 car garage with five (5) resident bedrooms, five (5) bathrooms, one (1) staff office area, a kitchen, dining area, and a living area. There are six (6) exits: One exit in main entrance, one exit in Resident Room #3, one exit in Resident Room #4, one exit in Resident Room #5, one exit in the living area, and one exit in the garage. Air/Heating: Central air/heating system installed with a central panel to control entire house located in the resident hallway. Temperature was at 75 degrees Fahrenheit. Staff Bedrooms: There is no staff bedroom. It is a staff office area for storage. Evaluation Report Continues on LIC 809-C Resident Bedrooms: There are five (5) Resident Bedrooms: Bedroom #1, Bedroom #2, Bedroom #3, Bedroom #4, and Bedroom #5. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings. Bathrooms: Two bathrooms have a working toilet, wash basin, and shower. Three bathrooms have a toilet and a wash basin. All bathrooms are clean. Shower mats were in all two bathrooms. Hot water was measured in all bathrooms. Hot water measured between 111.3 degrees Fahrenheit to 113.5 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 on the wall next to the kitchen. Menus and Activity Schedule is posted on the wall on which is next to the kitchen. Food Service: There is a 2-day perishable food. There is 7-day non-perishable food supply on hand. The emergency food, emergency water, and emergency supplies are stored in the kitchen cabinets. Toxins: All cleaning supplies and chemicals are kept locked under the kitchen sink and in the garage. 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 four (4) fire extinguishers that are fully charged and were purchased on June 25, 2026 and are mounted in the kitchen, garage, by the main entrance, and in the resident hallway next to resident bedroom #2. 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. One is the backyard and one is in the front yard. There are enough tables and chairs for all residents There is one outdoor gate that is self-closing and self-latching. There is one shed near the outdoor gate. Medications, First-Aid Kit & Book: The first aid kit and all medications are stored in the kitchen 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 kitchen cabinet. Reading Material, Games, Equipment & Materials: Activity supplies are stored in the living area shelves. Each bedroom has individual large screen TV. Living has a large screen TV. Appliances: There is one four (4) gas burner stove which lights unassisted, oven, microwave oven, a refrigerator in the kitchen, dishwasher, washer, and dryer. All appliances are clean and operational. Fire clearance: Fire Clearance approved by Orange County Fire Authority on July 7, 2026. Component III: Component three Orientation was completed with Applicant Yama Raawee during visit. 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 Yama Raawee.the state’s words, verbatim · CDSS document, Aug 26, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Yama Raawee (Managing Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On August 04, 2026, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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, Aug 4, 2026