Pre-licensing visit·December 16, 2025

Licensing Program Analyst (LPA) Vaid conducted an announced pre-licensing inspection. This is an initial application applying for Residential Care for Elderly to serve residents aged 60 and above. LPA met with Kenny Yu, applicant/licensee. The requested capacity is four (4). Fire clearance approved for four (4) non-ambulatory residents of which two (2) maybe bedridden in bedroom #1. Hospice waiver was approved for four(4). Advertising dementia special care program was submitted with application. Three (3) residents and two (2) staff at the facility at the time of visit. Fire clearance: Fire clearance was granted on 11/07/2025 for four (4) non-ambulatory residents of which two (2) maybe bedridden in bedroom #1. Hospice waiver was approved for four(4). Fire clearance is in place. Dementia care plan was submitted. Auditory devices are installed at all exits and operational. Currently zero (0) bedridden residents. Structure: The property is a single-family residence located in a neighborhood, consisting of two (2) bedrooms, one (1) bathrooms, kitchen, dining room, living room, laundry area. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Signal system: Facility does not have a signal system. Bedrooms for Residents : Bedrooms have night stands, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage. Bathrooms: Toilet, wash basin, bathtub/shower in bathroom is operable. Bedrooms are accommodated for residents. Grab bars are maintained for toilet, and shower. CONTINUED 809C................ Linens & Hygiene Supplies: Sufficient linen/supplies which include pillowcases, mattress pads, blankets and bedspreads are available. Adequate supply of linen, wash cloths and towels are observed. Food Service: Dishes, cups and flatware are stored in the kitchen cupboards, inspected and in good repair. Dishwasher in kitchen properly installed and functioning. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet in the kitchen and inaccessible to residents. Food supply consists of two days of perishable and two weeks of non-perishable was observed. Medications, First-Aid Kit & Book: Medication cabinet is installed with a key lock and is inaccessible to residents. First aid kit has a thermometer, tweezers, scissors, antiseptic, bandages, and gauze. Smoke Detectors: Dual Smoke /carbon monoxide detectors are tested and operable. They are in common areas and each bedroom. Appliances: Stove burners, oven, microwave, washer, and dryer were operational. Refrigerator is located in the kitchen and measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat. Toxins: Poisons, toxins, and cleaning supplies are locked and inaccessible to residents. They are stored separately from food source. Emergency Phone Numbers, Exit Plan, Signages and posters: Emergency Disaster Plan and Labor law poster are posted. Exit Plan are available for review. Outdoor activity area in backyard: Outdoor activity area is furnished with chairs and table and in compliance. Shaded area in the backyard at the outdoor activity area is provided. CONTINUED ON 809C................ Residents & Staff Files: Key lock cabinets for records of staff and residents are installed and available. Applicant will not handle cash resources for residents. Staff files were observed and complete. Residents files and medications were observed and are complete. Water Temperature: Tested at 109.8 degrees Fahrenheit. Menu and phone: Menus are available for review. Free landline telephone is available for residents’ use and operable. Fire extinguishers: Fire extinguisher is available in the facility and is new. Pool: No bodies of water located at the facility. Finding: Facility has three (3) non -ambulatory residents under hospice care, zero (0) bedridden residents residing at the facility since January 13,2025. Residents receive assisted daily living needs and services, toileting, bathing, grooming, and meals. On todays’ visit LPA Vaid requested, and obtained documents: Residents R1-R3, face sheet, pre-placement appraisal, physicians report and admissions agreement. LPA Vaid observed the residents are well groomed and are comfortable in their surroundings. Kenny Yu stated CAB (centralized application bureau) was aware the emergency placement. Does not have residents at Trinity HB facility. Exit: Component III Orientation was waived during this visit. Licensee has other facilities. A copy of this report was provided to applicant. LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, s/he has been instructed to communicate with the CAB Analyst who assigned to his/her application.