Pre-licensing visit·February 15, 2023

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Xu Han, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 08/01/2022. This is a change of ownership with persons in care. During the inspection, LPA and AP observed the following: Structure. This is a one-story home. Facility is a 4-bedroom, 4-bathroom, 1 story house with attached garage that is being used for storage. Facility telephone number is (949) 200-9378. Resident Bedrooms. The 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lamps, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms. There are no staff bedrooms. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 114.8 and 117.5 F degrees. Linens & Hygiene Supplies. New linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. 2 days perishable and 7 days nonperishable food supply reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen drawer. Toxins: observed locked in the garage and under the kitchen sink. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files. LPA reviewed resident and staff files. Fire clearance was approved by City of Costa Mesa Fire Prevention Inspector Ben Castillo on 12/08/2022. Backyard. Backyard exit gate is operational and unlocked. Component III was completed with AP during today’s inspection. Facility is currently operating under the liability insurance of current facility IRVINE COTTAGES / LANEY'S COTTAGES EASTSIDE A (306005954). AP will switch liability insurance to new facility once the application is approved. During the inspection, LPA and AP observed that there was no patio cover or outdoor seating for residents. AP agreed to purchase and install outdoor seating and an umbrella for provide seating and shade for the residents. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed the items listed above must be completed for the facility to meet Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to AP.