Routine inspection·September 19, 2025

On 9/19/25, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a required - 1 year inspection visit. LPA met with Licensee, Vinh Tran (S1), and Licensee Lisa Saephan (S2) and explained the purpose of the visit. An entrance interview was conducted. Administrator certification expires on 6/19/25. The facility is licensed to serve up to 6 non-ambulatory residents. Hospice waiver approved for 3. Current census is 5. LPA toured the facility with S1. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. LPA observed staff preparing and serving lunch to residents during this visit. The hot water temperature was measured at 115.8*F which was within the required range of 105-120*F. The temperature inside the facility measured at 70* F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. LPA requested resident and staff files for review. LPA reviewed (4) staff files and (5) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. Report continues on 809-C The following forms and documents were requested during today's visit: Updated LIC 500 Personnel Report, updated LIC 9020 resident roster, updated LIC 999 Facility Sketch , and LIC 610 Emergency Disaster Plan (with signature) Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited. An exit interview was conducted, and a copy of this report was provided to facility.