Pre-licensing visit·December 19, 2023

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Staff #1 (S1) Zepta Tamba, discussed the purpose of the inspection, and toured the facility. Applicant (AP) Jacklyn Peng L Concepcion arrived during the inspection. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 07/13/2023. This is a change of ownership with persons in care. During the inspection, LPA and AP observed the following: Structure: facility is a 4-bedroom, 2-bathroom, 1-story house with detached garage that is being used for storage. Facility telephone number is (714) 671-8329. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lights, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms: the 1 staff bedroom is spacious and will easily accommodate the staff’s furnishings. Bathrooms: were clean, faucets and toilets were operational. Water temperature: tested at 109 degrees F in the resident bathroom. 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: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen drawer. Toxins: observed locked in the kitchen and garage. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files: LPA reviewed 3 resident files and 1 staff file. Fire clearance was approved by Anaheim Fire Department on 09/08/2023. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. Facility is currently operating under the liability insurance of current facility ANGEL ROSE RESIDENCE (306005228). AP will switch liability insurance to new facility once the application is approved. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.