Pre-licensing visit·May 19, 2025

Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Administrator (AD) Jenny Phung. An application to operate a Residential Care Facility for Elderly (RCFE) was received by our agency on January 06, 2025 for a total capacity of six non-ambulatory only. Fire clearance was approved by a fire inspector from the Orange County Fire Authority on February 11, 2025. The facility is a one-story home with three resident bedrooms that are shared rooms, one staff room, two bathrooms, a living room, a kitchen, a dining area, and an attached two car garage. There is one gate on the right side of the house that is self-latching and unlocked. There is no seating area with shade for residents in the backyard or outside. LPA did not observe any administrator certificates post on the wall. The Ombudsman and The See Something, Say Something poster (PUB 475) were small and did not meet the department standards. LPA did observe Personal Rights and Facility sketch posted up on the hallway walls. There was no Emergency Disaster Plan posted in the facility. LPA advised administrator that notices and postings needs to be visible to residents and visitors in an area like the front entry way. Fire extinguisher is in the dining room by the kitchen fully charged. Fire alarms and carbon monoxide detectors worked properly and are operational. Resident bedrooms did not meet the required furnishings. There is a lamp missing in one room. Chairs are not provided for all residents in the facility. LPA observed all beds had linens and blankets. The toxic chemicals, cleaning solutions, and disinfectants have no designated locked secured area for storage. Medications will be stored in a locked cabinet in the hallway. The first aid kits are in the staff room and are incomplete, the kits are missing thermometers. There is no first aid book. Staff and resident records will also be stored and locked in the cabinet in the hallway. LPA observed activities such as board games, puzzles and reading materials provided by the administrator in the staff room. There is a phone for residents to use. Pre-licensing Inspection continued on LIC809-C There is a laptop for residents to use. A supply of non-perishable food was observed, and perishable food will be maintained on hand. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. There is no secured locked storage for sharps in the kitchen. The hot water temperatures in the bathrooms measured between 120.7 Fahrenheit degrees and 122.1 Fahrenheit degrees. LPA explained to the administrator that water temperature needs to be between 105 to 120 Fahrenheit degrees. There is no emergency food and water, and additional emergency disaster supplies observed at the facility. Licensee will need to address the following issues and need to be corrected to be licensed: · Walls of the facility need to be clean, there is dirt, dust, cobwebs · Bathroom and sinks need to be cleaned · Nonslip bathmats in each shower · Grab bar is missing in shower of Bathroom #1 · Air vents need to be cleaned of dirt and cobwebs · Crack in ceiling wall needs to be repaired · Crack on Bedroom #2 Door needs to be fixed · Chairs for each resident in the rooms, a total of 6 chairs · Lamp is missing for Bedroom #3 · Needs to be door for Bedroom #3 for resident privacy · Shaded patio furniture and umbrella for residents outside · Administrator certificate needs to be posted · Pub 475 “See Something Say Something” Poster needs to be 20x26 · Ombudsman Poster needs to be 20X26 Pre-licensing Inspection continued on LIC809-C · Notices and personal rights to be posted in front entry way area · First Aid kit is missing: thermometer · First Aid booklet by American Red Cross or American Medical Association · Window and door alarms or alerts · Emergency food, water · Emergency disaster supplies · Locked cabinet for knives/sharps in the kitchen · Locked cabinet for chemicals/toxins in the kitchen or laundry area · Need to see samples of Admission Agreement for files The facility is not ready to be licensed. Licensee will contact the LPA to schedule a second Pre-licensing visit when corrections are completed. An exit interview was conducted, and a copy of this report was provided to Licensee.