Pre-licensing visit·March 4, 2024

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived and was greeted and granted entry by Administrator Dennis Bui and Licensee Kevin Dinh. An application to operate a Residential Care Facility (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by Community Care Licensing (CCL) on 12/4/2023. The facility is the first floor of a two-story home. The second floor is not included in the facility's fire clearance and residents do not have access to the second floor. The facility houses three shared resident bedrooms, two bathrooms, living room, dining room, kitchen, detached two car garage and backyard with pool. LPA did not observe any obstructions blocking the exit gates or obstacles or hazards in the backyard. Client Bedrooms have all the necessary requirements including bed, chair, storage for clothing and ample lighting. LPA observed all windows were screened. All bathrooms have working plumbing and designated hand washing posters. Hot water heater is set to 115 degrees Fahrenheit. Pool: The facility has a pool in the backyard. The pool is enclosed on its two shorter sides by a brick wall. It's two longer sides are enclosed by a pool patio area and brick wall on one side and an iron fence on the side closer to the house. The iron fence is five feet high with four inches of space between each vertical bar and four inches of space between the bottom of the fence and the ground. The iron fence has a door that opens away from the pool. It is self-latching. LPA observed the fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. LPA observed a receipt for the fire extinguisher which indicates the it was purchased on 1/6/2024 LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and are stored and locked in the kitchen and garage. Medications, First-Aid Kit, Resident & Staff Files will be locked in cabinets in the kitchen and hallway. The fire clearance was approved by a fire inspector of Orange County Fire Authority on 1/11/2024. A supply of extra linens is stored in the closet under the stairs. Emergency Phone Numbers, Exit Plan, PUB475 are all posted and available for review. Smoke and Carbon Monoxide detectors are stationed throughout the home and are wired together. Both types of detectors were tested and noted as operational. Operational appliances include a gas stove, oven, refrigerator, dishwasher, microwave, washing machine and dryer. LPA reviewed and provided Licensee with the Component III presentation to offer information and resources regarding maintaining facility compliance. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.