Pre-licensing visit·March 28, 2023

Licensing Program Analysts (LPAs) Dang Nguyen and Alyssa Ramirez conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to the Applicant’s Representative, Jean Paul Reyes. Applicant Hong Hanh Le Dao also joined today's visit via video teleconference. The facility fire clearance was granted on 02/28/2023 and reflects that the facility was approved for six (6) residents in total, of which two (2) may be non-ambulatory in Bedroom #4 (per the facility sketch), and none may be bedridden. During today’s visit, LPAs, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was 69 degrees F. Water temperatures at taps accessible to residents were compliant: Bathroom #1 sink was 118.2 F, Bathroom #2 sink was 118.8 F, and Kitchen sink was 117.2 F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. Refrigerator temperature was 38 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of medication and confidential client and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. One (1) fire extinguisher and one (1) first aid kit were present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Applicant Hong Hanh Le Dao was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.