Pre-licensing visit·May 12, 2025

On May 12, 2025 at 8:45 AM, Licensing Program Analyst (LPA) Brandon Lopez made an announced visit to the facility to conduct the pre licensing inspection. LPA was greeted and granted entry into the facility by Administrator (AD) Even Tran. LPA observed that Evan Tran has a valid Administrator certificate which expires January 2, 2026. An initial application to operate a Residential Care Facility for the Elderly (RCFE) for a capacity of six (6) non-ambulatory residents, one of which can be bedridden in bedroom four, and has a hospice waiver for six, was received by Community Care Licensing (CCL) on November 18, 2024. This is an initial application with no residents in care. The facility received an approved Fire Clearance by the Huntington Beach Fire Department Inspector Christopher Bird on March 7, 2025. The facility is a single story home with four resident bedrooms, two of which are shared, two shared resident bathrooms, a living room, a dining room, a kitchen, a sun room, a laundry room, and an attached two car garage. On today's visit, LPA accompanied by the AD conducted a tour of the interior portions of the facility. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have beds and lamps. LPA observed chairs missing in all four resident bedrooms. LPA observed the chest of drawers to be missing in bedroom three. LPA observed resident beds to have clean mattresses, linens, and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms and observed them to be free of hazards. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 116 to 116.9 degrees Fahrenheit. LPA observed a light bulb missing in bathroom two. CONTINUED ON 809-C LPA observed kitchen appliances such as the refrigerator, the dishwasher, and the microwave to be clean and operational. LPA observed that one out of the four burners on the gas stove was not operational. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed a fire extinguisher in the kitchen and in the two car garage. Fire extinguishers charged and serviced as December 6, 2024. LPA tested the wired smoke detectors which tested operational. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the fire place in the living room to not be in operation at time of visit. LPA observed activity materials such as books, games, and coloring books, and a piano to be stored in the living room. LPA observed that staff files and resident files will be kept in a storage cabinet in the living room. LPA observed the facility did not have a dedicated internet device for resident use. Per the AD, the centrally stored medication will be kept in a locked closet by the dining room. LPA observed the facility has a three day emergency food and water supply stored in the closet. LPA observed chemicals and toxins to be stored in a locked cabinet in the laundry room. LPA observed the door leading to the attached two car garage to be kept locked. LPA observed the two car garage to be used for storage. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. LPA observed construction materials to be in the passageway on the southside of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter of the facility are self-latching can be opened in an evacuation. There are no bodies of water on the premises. LPA advised AD of the following corrections that need to be made: Purchasing chairs for all four resident bedrooms Purchasing a chest of drawers for bedroom three Purchasing and hanging the See Something, Say Something poster (PUB 475) by the entryway Installing a new light bulb for bathroom two Removing the construction materials from the passageway on the southside of the facility Repairing the burner of the gas stove that currently does not work Purchasing an internet device for resident use Component III was not completed on today's visit and will be conducted on the subsequent visit. An exit interview was conducted with Administrator Evan Tran and a copy of the report was provided.