Pre-licensing visit·October 23, 2024

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility and was greeted and granted entry by designated Administrator (AD) Thomas Vu and Manager (M) Tina Vu. An application to operate a Residential Care Facility for Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on 12/13/2023. The facility is a one-story home with four resident bedrooms, two resident bathrooms, common area, kitchen, backyard and an attached two car garage. The back yard has two exit gates on one both sides of the house and two shaded seating areas. There is a second unit on the property that houses 3 bedrooms and 2 bathrooms. AD stated that he, his wife and his son will be living back there and that it is not part of the facility. The back house also has a different address than the facility address. All resident bedrooms had the required furnishings and ample lighting. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. All and any toxic chemicals are inaccessible to residents and will be stored and locked in the garage. Medication, First Aid Kit and Manual are stored in a locked closet near the entryway. The first aid kit has all the required elements. Fire extinguishers are fully charged and was purchased on 11/11/2023 as indicated by the receipt. The facility has books, magazines, a piano and televisions for resident activities. Fire clearance was approved by a fire inspector of Fountain Valley Fire Department on 6/4/2024. Component III was conducted. All bathrooms have working plumbing and designated hand washing posters. Hot water measured between 105-120 degrees Fahrenheit in the three resident bathrooms. Resident bathrooms also have shower mats in showers. Emergency Phone Numbers, Exit Plan & Menu are posted and available for review. Smoke detectors and carbon monoxide detectors tested operational. Appliances are operational. 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.