Senior Care Records.

Facility Evaluation Report

Evergreen Care Home, Buena Park11/04/2025Licence 306003773

Capacity6
Census6
Date signed11/04/2025 04:39:22 PM
Name of licensing program analystHanna Gough
Name of licensing program managerArmando J Lucero
The inspector’s account

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct the annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Haeryun Cho and discussed the purpose of the visit. The facility currently has six residents in care.

The facility is a two story home with the upstairs being the licensee’s living quarters. There are four resident bedrooms, three bathrooms, a living room, kitchen, and attached two car garage on the first floor of the facility. The facility appears clean, safe and sanitary. LPA observed the resident bedrooms to have all the required components and furnishings. LPA observed the bathrooms to have toilet paper, paper towels and textured flooring in the shower. LPA observed the toxins and chemicals to be locked under the bathroom sink located in the hall behind the living room. LPA tested the water to be between 110.3-111 degrees Fahrenheit. LPA observed clean linens in a hall cupboard. LPA observed the kitchen to be clean and free of vermin. LPA observed the knives to be locked and stored in the kitchen cabinet by the stove and made inaccessible to residents in care. LPA observed the stove burners to not work without a lighter. LPA observed the centrally stored medication to be locked in a kitchen cabinet and made inaccessible to residents in care. LPA observed the emergency food to be located in the entry way of the facility. LPA observed the garage to be used as extra storage and is locked and made inaccessible to residents in care. LPA observed the backyard has a shaded seating area for resident use and is free of debris and obstructions. LPA and AD tested the carbon monoxide and smoke detectors and they were found to be operational.

LPA reviewed staff files and 1 of 2 staff do not have a health screening on file. LPA observed 1 of 2 staff do not have updated annual training. LPA reviewed 3 resident files and 3 of 3 residents do not have an updated needs and services plan on file.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction