Routine inspection·May 23, 2025

On May 23, 2025, at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Allen Jao. Administrator (AD) Kevin Dinh was contacted via telephone and arrived at the facility a short time later. AD Kevin Dinh has an administrator certificate with an expiration date of 10/15/2025. The facility is a single level structure, licensed for six (6) non-ambulatory residents of which on may be bedridden and a hospice waiver for six (6) residents. The home consists of the following: Four (4) resident bedrooms, three (3) bathrooms, living room area, dining area, kitchen, outdoor covered patio seating area, and an attached two car garage. During the visit, LPA Bentley toured the interior and exterior of the physical plant with CG Jao and AD Dinh and the following was observed: There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were available, lighting was provided, and storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be clean and operational. The water temperatures in three bathrooms measured 109.7 degrees F to 114.6 degrees F. A comfortable temperature of 73 degrees F was maintained throughout the facility. CONTINUE TO LIC809-C PAGE LPA Bentley observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for cleaning supplies, toxins, and sharps objects were not securely stored and locked and a deficiency is being cited. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available. There is a two car garage that as two three entry points of which two out of three was kept unlocked throughout the inspection. There is a refrigerator in the garage with an additional supply of perishable items and resident medication found stored inside, unlocked at the time of the visit, for which a deficiency is being sited. The washer and dryer were observed to be in working condition. Facility has emergency food supply and water supply. A covered patio area with tables and chairs was observed. The backyard and front yard were found unkept and not well maintained. A technical violation was issued for the yards and a screen door on the garage door, found with holes and in disrepair. Emergency safety drill was last conducted on March 10, 2025 and are conducted quarterly. First aid kit is maintained and contains all the necessary elements. Smoke and carbon monoxide alarms were tested and observed operational. A working telephone (714-798-7218) remains available, and the facility has a device that can be used for video teleconference purposes. The facility has one (1) fire extinguisher in the kitchen that was charged and last serviced on March 21, 2025. Liability Insurance is effective September 15, 2024 through September 15, 2025. LPA Bentley conducted an audit of six (6) resident files (R1-R6), four (4) staff files (S1-S4), conducted three (3) staff interviews, and five (5) resident interviews. A review of the Medication and Medication Administration Record (MAR) was conducted. Based on today’s observations, four deficiencies and a technical violation were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report, deficiency pages, and appeal rights were provided to Administrator Kevin Dinh.