The proposed physical plant is a two (2) story single family dwelling located in a residential neighborhood of Santa Rosa Valley, CA. A tour of the physical plant was conducted and the following observed:

COMMON AREAS: These include the Family Room and Dining Room. Additionally, the attached 3-car garage will be used as a Gym/Recreation Room. The common areas were furnished to accommodate a maximum capacity of six (6) residents. There is a fireplace in the Family Room as well as Family Therapy Room, which were observed to be adequately screened and Licensee Representative stated is disabled. There were no immediate hazards observed. A COVID-19 Screening & Hand Sanitizing Station was observed at the entrance to the facility. Fire extinguishers were observed throughout the facility; all were observed to be fully charged and last serviced 03/31/2022. At 11:00AM, hardwired combination carbon monoxide/smoke detectors were tested and were functional at the time of the visit.

TREATMENT/THERAPY, MEDICATION ROOM & OFFICE AREAS: There is a Group/Family Room, Family Therapy Room, Medication Room, and two (2) offices located on the ground floor. There is also a Learning Lab located on the second story as well as one (1) additional office. Medications are stored in a locked first floor Medication Room. The medication room has adequate locked storage, as well as a locked refrigerator. The 1st Aid Kit is stored in the Medication Room. The Offices are kept inaccessible to clients unless properly supervised.

Report Continued on LIC 809-C

LAUNDRY: Locked Laundry Room is located on the ground floor. Laundry and cleaning supplies will be stored in locked closet inside the locked Laundry Room.

KITCHEN: Appliances and fixtures appeared clean and functional. Licensee representative informed LPA three (3) of the four (4) burners on the stove are non-functional and will be repaired within the week. LPA confirmed the one (1) burner was functional at the time of the visit. There was sufficient nonperishable food to accommodate a maximum capacity of 6 Clients for (seven) 7 days. There was sufficient dining and cook ware to accommodate a maximum capacity of 6 Clients. Cleaning supplies will be stored in locked under-sink cabinets. Knives and other sharps will be stored in a locked cabinet in an inaccessible office. There were no visible immediate hazards observed.

BEDROOMS: There are three (3) Bedrooms, all of which are designated for Resident use. All bedrooms are located on the second story and furnished for double occupancy. All bedrooms were equipped and supplied with appropriate furniture, bedding and linens. There were no visible hazards or discrepancies observed.

BATHROOMS: There are five (5) Bathrooms, two (2) on the ground floor and three (3) on the second floor. The bathrooms located on the ground floor include a full bath attached to the office designated for client use and a half bath in the main hallway for staff use. The bathrooms located on the second floor are all full bathrooms and two (2) are designated for client use. 1 upstairs bathroom is designated for staff use only. All Bathrooms were supplied with appropriate paper and hygiene products. Water temperatures were measured in all client bathrooms and measured within the required range of 105 degrees F to 120 degrees F at the time of the visit.

SURROUNDING GROUNDS: The Front Yard includes a driveway, paved walkways and landscaped areas. The backyard is fenced and includes both paved and landscaped areas, a patio, furniture appropriate for outdoor use, shade an in-ground swimming pool, as well as a stable and barn, and open space. The pool is kept inaccessible to clients with the use of fencing that includes a locked gate. The Applicant Representative and Administrator confirmed they are aware of the requirement of Water Safety Certification for staff providing supervision during pool use and that qualified staff must be present at all times that the pool is in use by clients. During the visit, LPA and Applicant Representatives observed loose cinder blocks, bricks, as well as

Report Continued on LIC 809-C

loose concrete pieces. Additionally, LPA observed re-bar protruding from a small wall/piece of concrete in the open backyard area.

COMPONENT II/COMPONENT III ORIENTATION: A Component II Orientation was completed telephonically with the Licensee Representative and Administrator on 05/24/2022. A Component III Orientation was conducted with Licensee Representative Tiai Salanoa and Administrator Leo Vaca during today's visit.

COVID-19 MITIGATION PLAN REPORT: During today’s visit, LPA reviewed the facility’s Plan for Epidemic Outbreak specific to COVID-19 Mitigation Plan Report.

The following needs to be completed/Photos sent to LPA prior to licensure:

• Remove all debris/potential hazardous items from the outdoor space, including all loose concrete, cinder blocks, and bricks
• Remove protruding re-bar from the concrete slab/wall in the outdoor open space
• Replace the 4 (four) missing screens that are currently missing and are on order

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted. A copy of the Licensing Report was provided via email.