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Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing inspection at this facility with the Administrator. Cassandra Moan CA ID reviewed. LPA conducted a guided facility tour of both the inside and outside with the administrator Cassandra Moan, Ivan Saa, Director of Health and Wellness, and Eduardo Sierra, SRM General Contractor. The facility was inspected for Fire Safety, Personal Accommodations and Services, Medication Procedures and Food Service. A fire clearance was approved on September 22, 2025, for thirty-five (35) ambulatory residents, one hundred thirty-three (133) non-ambulatory residents and thirty-two (32) bedridden residents. The facility has a total capacity of two hundred (200), with one hundred forty-four (144) bedrooms and one hundred forty-four (144) bathrooms, in addition to common bathrooms located on floors one (1), two (2), and six (6). Resident bathrooms are equipped with properly installed grab bars. During the visit, hot water temperatures were measured between 105ºF and 117ºF, within the acceptable range. The facility also features model rooms that were observed to be adequately furnished. The common areas, theater, activities rooms, sky lounge, gym, salon, and dining areas were appropriately furnished. The LPA Smith observed the theater room, activity room, lounges furnished and equipped appropriately. Designated locked medication rooms have ample space, and medication carts. There is a total of five (5) first aid kits in the facility with one (1) of the first aid kits located in the facility vehicle. LPA inspected the kitchen and observed the stove, refrigerators, and freezer room to be clean and working. Pantry is stocked and facility has emergency food supply and water. Smoke detectors and Carbon Monoxide detectors are centralized and emergency services are dispatched automatically. There are fully charged fire extinguishers located throughout the building and observed to be last inspected 11/2025. LPA Smith observed a commercial laundry room on first floor and one hundred seven (107) in room washer and dryers. There is sufficiently shaded outdoor space on first, second, and sixth floor with ample seating and new furniture for outdoor use. There are no bodies of water on the premises. At the time of this visit the physical plant is meeting Title 22 requirements. Component III presentation completed at 3:45 pm and administrator acknowledged understanding. No health and safety hazards were noted during this visit. Copy of this report will be forwarded to the CAB specialist. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Nov 12, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 200 Interview Method: Virtual interview (Microsoft Teams) On 10/7/2025, applicants/administrator participated in COMP II. Identification of the applicants and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicants 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, Oct 7, 2025