Pre-licensing visit·March 6, 2024

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Rosie Dang, 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 09/25/2023. This is an initial application with no residents in care. During the inspection, LPA and AP observed the following: Structure: this is a two-story home. Facility is a 6-bedroom, 3-bathroom, 2 story house with an attached garage that is being used for storage. There is a back yard with a patio cover for the residents. Facility telephone number is (714) 583-8174. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 130 F degrees. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers and Exit Plan: reviewed. Food Service: 7 days nonperishable food supply reviewed and AP stated they will obtain 2 days perishable food supply prior to accepting residents. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: inspected. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet is locked. First-Aid Kit and Activity Supplies: observed and available. Resident & Staff Files: this is an initial inspection and LPA observed storage space for resident and staff files. Fire clearance was approved by Orange County Fire Authority on 12/11/23. Backyard: 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. AP will obtain liability insurance once the application is approved. During the inspection, LPA and AP observed the following: the water temperature in the east resident bathroom tested at 130 F degrees. The resident bedrooms did not have lamps. The facility has a second floor which is not reflected on the floor plan. AP stated they will correct these issues and notify LPA once they have been corrected. Regarding the fire clearance, AP stated they will request a new fire clearance clearing the “Reception/Staff Office” room as either a resident bedroom or staff bedroom and clearing the second floor for 2 staff bedrooms, a bathroom, and a small common area. AP stated that the new facility sketch will reflect these changes and include the second floor. 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 item(s) 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.