Routine inspection·April 28, 2026

On April 28, 2026, at 2:00 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator Chin-Wen Cheng. The facility is licensed to operate for six (6) non-ambulatory, of which one (1) may be bedridden and have a hospice waiver for three (3) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one staff bedroom, three (3) bathrooms, living area, laundry room, dining area, kitchen, outdoor covered seating area in the front yard and backyard, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Cheng. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. LPA observed the staff bedroom had an area that was not fully enclosed that contained a bed and red curtain setup. This area was not closed of fwith a fourth wall and door. Staff stated that a staff member was sleeping there Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 114.8 degrees F to 117.2 degrees F. A comfortable temperature of 77 degrees F maintained in the facility. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Emergency food, emergency water, and emergency supplies are stored in the garage. A working telephone (714-982-8145) remains available. Last emergency drill was conducted on April 9, 2026. The facility has two (2) fire extinguishers which are located and mounted next to the garage and near resident room #3. Both fire extinguishers were last serviced on December 3, 2025 Evidence of liability insurance is effective February 22, 2026, and expires on February 22, 2027. Due to time constraint a continuation of this inspection will be conducted at a later date. LPA will conduct an audit of records for residents and medication and medication administration record, LPA will inspect the first aid kit, and LPA will conduct interviews with staff and residents. A Deficiency was cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed the staff bedroom had an open area next to the bedroom and bathroom where a staff was sleeping in. There was bed set up in this area with a red curtain. During the visit, the facility removed the bed and red curtain from the area. An exit interview was conducted, and a copy of this report, LIC809D, and appeal rights were provided to Administrator Chin-Wen Cheng.