Facility Evaluation Report

Licensing Program Analyst (LPA) Brandon Lopez made an announced visit to the facility to conduct the Prelicensing inspection. LPA was greeted and granted entry into the facility by Administrator Khanh Nguyen. LPA observed that Khanh Nguyen has a valid Administrator certificate that expires on July 17, 2026.

An initial application to operate a Residential Care Facility for the Elderly (RCFE) for a capacity of six (6) residents, of which three may be non-ambulatory and has a hospice waiver for two, was received by Community Care Licensing (CCL) on October 21, 2024. This is an initial application with no residents in care. The facility received an approved Fire Clearance by the Fullerton Fire Department Inspector Peggy Castaneda on June 20, 2024.

The facility is a single story home with three resident bedrooms, two resident bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. On today's visit, LPA accompanied by the AD conducted a tour of the interior portions of the facility. LPA observed the See Something, Say Something poster (PUB 475) mounted by the entryway of the facility. LPA inspected the three resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. 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 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 109.4 to 109.5 degrees Fahrenheit.