The Gate of Beautiful III

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 05/11/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregiver, Carrie Phommarath, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator to inform them that CCL was present at this time. The facility designated representative, Sophia Patterson, arrived shortly thereafter to this facility and was briefly interviewed at this time. Current census was 3 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (4) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there were (2) residents receiving services through home health at this time. It was learned that this facility does have an approved bedridden fire clearance to be able to accept or retain any residents deemed to be bedridden at any given time. There weren't any residents deemed to bedridden at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Laundry area was toured and observed to be locked at this time. A review of the bleach, detergent, and all other cleaning supplies was conducted to make sure that they were locked and made inaccessible to the residents at this time. Administrator certificate # 7022645740 for Sophia Patterson was observed to have an expiration date of 07/06/2026 and in compliance at this time. Medication cabinet, located in the facility hallway cabinet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher located hanging on the wall adjacent to the kitchen was observed to have been annually purchased from the local hardware store, Home Depot, on 05/03/2026 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at all times. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted and noted on the following LIC 859. A review of (3) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 05/11/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregiver, Carrie Phommarath, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator to inform them that CCL was present at this time. The facility designated representative, Sophia Patterson, arrived shortly thereafter to this facility and was briefly interviewed at this time. Current census was 3 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (4) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there were (2) residents receiving services through home health at this time. It was learned that this facility does have an approved bedridden fire clearance to be able to accept or retain any residents deemed to be bedridden at any given time. There weren't any residents deemed to bedridden at this time. Tour of this facility was conducted. This Post Licensing visit was conducted along with the annual visit as well. There were no deficiencies observed or cited during today's Post Licensing visit. Exit Interviewthe state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jason Lund arrived announced at the facility to conduct a pre-licensing visit. LPA Lund met with Administrator Nicole Ell Residents and explained the reason for the visit. Census: 0 The facility is a one-story dwelling. LPA toured the facility including dining area, kitchen, family room, (4) bedrooms, (2) bathrooms, laundry (washer/dryer), garage, and yard. There is no pool present. Walls, floors, windows, and doors are in good condition. Fixtures and furniture are in good condition and there is adequate storage space. Facility central heating and air is operational and temperature is at 74.5 degrees (F). Smoke alarms, carbon monoxide detector, and fire extinguisher (May 2025) are operational. There is a locked area for centrally stored medications. The facility has 7-day nonperishable and 2-day perishable food and is compliance. Facility has adequate dishes, utensils, glasses, etc. Linen supply and personal hygiene supplies are available. Bathrooms have non-skid mats, grab bars, along with night-lights outside the entrance. Facility has sufficient space to accommodate indoor and outdoor activities. The Pre-Licensing Inspection Tool was utilized during the course of this visit. The facility was determined to be in substantial compliance with the Health and Safety Code and the California Code of Regulations. The facility has passed the pre-licensing inspection. Component III was conducted. An exit interview was conducted and a copy of this report was provided to Licensee Nicole Ell.the state’s words, verbatim · CDSS document, May 1, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 4 Census (if any clients in care): 0 COMP II Participants: Nicole Ell (Board Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On February 19, 2025, 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, Feb 19, 2025