Pre-licensing visit·December 16, 2025

Licensing Program Analysts ( LPAs) Cynthia Chan and Elena Mallett conducted an announced pre-licensing visit on 12/16/25 with Applicant Phuoc Troung. The fire clearance is approved for 6 residents, ages 60 and over. (1) may be bedridden and (5) can be non-ambulatory. Bedroom # 1 is approved for (1) bedridden resident. The applicant has submitted a request for a hospice waiver to the Centralized Applications Bureau (CAB). The Prelicensing visit was conducted utilizing the CARE (Compliance and Regulatory Enforcement) tool. The following domains were assessed: Infection Control: The licensee has developed an Infection Control Plan and designated a lead staff to conduct training. Facility has sufficient PPE supplies and will provide on-going training to staff on infection control. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. Structure/Physical Plant: The facility is a single-story home in the residential area of La Puente. The home consists of 5 bedrooms. Bedroom room #1 is a shared bedroom with space for one non-ambulatory resident and one bedridden resident. Bedrooms #2- #5 are private rooms for non-ambulatory residents. There is an open living room, dining room area, 2 bathrooms, laundry room, and a kitchen. Bathrooms have non-skid mats in the shower area and grab bars. The backyard has a shaded area with a table and chairs. There is a portable storage shed in the back yard. Residents’ rooms have adequate lighting and the required bedroom furniture. Extra linens and hygiene supplies were observed. Hallways leading to shared bathrooms had night lights. All walkways were free of debris and obstruction. No swimming pool or bodies of water on the premises. The toilets were functioning properly and the hot water temperature measured within required range. Facility has an operable smoke detector in each room and a carbon monoxide detector located near resident rooms. There were 2 fully charged fire extinguishers observed. Knives, cleaning solutions, and disinfectants are locked. No firearms or weapons stored at the facility. The facility has an auditory device on each exit door. Video surveillance was observed in the common areas. Food Service : There is a sufficient food supply of 2 day perishable and at least a week of non-perishable food maintained at the facility. The kitchen is kept clean and sanitary. All the appliances were in working order. Sufficient amount of tableware, dishes, and utensils are observed. The refrigerator is maintained at 40 degrees F or below and the freezer at 0 degrees F or below. The knives and sharps are stored and locked in a cabinet. Staff and Residents files: Staff and Residents files will be stored in a locked cabinet near the dining room. Planned Activities : The facility has sufficient space to accommodate indoor and outdoor activities. A list of planned activities was provided. Incidental Medical and Dental: Medications will be centrally stored and locked inside a cabinet near the dining room. The first aid kit was observed to contain all the required supplies along with the current first aid manual. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: The facility will accept and retain residents with dementia and/or hospice. The facility phone number is (323) 258-8879. Component III was conducted with the applicant. The physical plant is cleared; however, the following shall be submitted to LPA and the CAB Analyst by 12/23/25. · verification of the Complaint poster with 20” X 26” in size · Long Term Care Ombudsman poster · Update Plan of Operation to include video surveillance (refer to EM 2-5800) and submit to CAB for review · Liability insurance shall be secured upon licensure. An exit interview was held, and a copy of this report was given to the applicant.