Pre-licensing visit·June 19, 2025

On June 19, 2025 at 10:45am, Licensing Program Analysts (LPAs) Eboni Bentley and Jessica Cho arrived announced for the purpose of conducting the Pre-Licensing visit for an Initial Application. LPAs conducted the visit with Applicant/Chief Executive Officer (CEO) Tin Le and family member Brian Conseco. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on August 19, 2024 for age range 60 and over. LPAs toured the facility's indoor and outdoor physical plant with Applicant Tin Le and family member Brian Conseco. Please note that the Applicant is currently residing at the facility and expressed intent to relocate and use facility solely for residents with the date of move being unknown at this time. The following were observed: Structure: The facility is a single-story property in a residential neighborhood comprised of four resident bedrooms with two resident full bathrooms, of which one bathroom is in the master resident bedroom. Currently, the master bedroom is occupied by the applicant. All bedrooms will be for resident use. LPAs observed all common areas which includes the living room, dining area, kitchen, and an attached two car garage which doubles as a laundry area. Telephone Number: Facility does not currently have a land line. CONTINUE TO LIC809-C .... Liability Insurance: Facility does not currently have liability insurance. Signal System: No signal system. Bedrooms: The resident bedrooms had all required components, are spacious, and easily accommodates the residents’ furnishings. All rooms and closets contained personal items belonging to the applicant and will be removed and ready for resident use. Bathrooms: Bathrooms were clean and operational with slip resistant mats in place. Grab bars were not present. Linens and Hygiene Supplies: Clean linens were fully stocked however the hygiene supplies for resident use were not observed. Appliances : Stove burners, microwaves, refrigerator, freezer, and washer/dryer were inspected and operating. Resident and Staff Files: Resident and staff records will be maintained on site. Medication: Medication will be secured in a closet by the garage. Reading Material, Games, Equipment, & Materials: The facility maintains games and activities in the living room area. CONTINUE TO LIC809-C .... Emergency Phone Numbers/Exit Plan: Posted on the bulletin boards. Postings: The See Something, Say Something (PUB475) was in the correct size and the Ombudsman Posters were posted by the entry way as well as the Rights of the Resident Councils, Resident's Rights, and Theft & Loss Policy. The Activity Schedule, Food Menu, and a copy of the Admission Agreement was missing. Food Service and Menu: Supply of seven-day non-perishable and two-day perishables were observed in the kitchen cabinet and garage. The emergency food/water supply were also available in the garage. Smoke and Carbon Monoxide Detectors: The smoke detectors and carbon monoxide alert systems were tested and found operational. Fire Extinguishers: A fire extinguisher was mounted, fully charged, and serviced on October 8, 2024. Fire Clearance: Approved on November 18, 2024 for 6 ambulatory residents. CONTINUE TO LIC809-C .... Sharps and Toxins: Sharps were observed to be secured and inaccessible. Cleaning supplies and toxins were observed in the locked garage, and Applicant stated they plan to relocate all to a locked cabinet in the garage. Water Temperature: The water temperature in the two resident bathrooms measured at 103.8 and 107.2 degrees Fahrenheit. Medications, First Aid Kit, & Manual: The First Aid Kit and manual were checked and found to be in order. Component III: Component III was waived because Applicant is operating other licensed facilities and has fulfilled this requirement. The following items require correction: · Clear passageway (soil/hose) in the yard · Install grab bars in the resident bathrooms · Ensure all medications, sharps (gardening tools, scissors), and toxins (cleaning solutions) are inaccessible and secured at all times · Ensure that the home/resident’s bedroom spaces are de-cluttered and ready for use · Ensure all emergency supplies which include but are not limited to such as whistles are obtained per the Emergency Disaster Plan (LIC610E) CONTINUE TO LIC809-C .... · Amend the LIC610E reflecting the type of residents served · Missing postings- food menu, activity calendar, sign in and out area, and admission agreement. · Submit proof of liability insurance policy Based on today’s observation, the facility is not ready for licensure. A subsequent visit will be conducted to review the corrections some time towards the end of the year and Applicant will contact the department if an extension is needed or when the inspection date is requested. An exit interview was conducted with Applicant Tin Le and family member Brian Canseco, and a copy of this report was provided at the end of the visit.