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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004758
Report Date: 06/01/2022
Date Signed: 06/01/2022 12:09:30 PM


Document Has Been Signed on 06/01/2022 12:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:A&B AT HOME HEALTH HOME CARE FACILITY RCFEFACILITY NUMBER:
306004758
ADMINISTRATOR:JOIEY WSAA J. ONGFACILITY TYPE:
740
ADDRESS:24116 JUANENO DRIVETELEPHONE:
(949) 870-6588
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
06/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Administrator Joiey Ong TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection to this facility. LPA met with Administrator (AD) Joiey Ong and stated the purpose of this visit.

This facility is a single level structure and licensed for six non-ambulatory of which all may be bedridden and with hospice waiver for four. and with hospice waiver for four. For this visit, there was 1 resident under hospice care.

LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed six residents in care and two staff members on the floor. There were six private rooms. Rooms were provided with furniture in good repair, clean linens, and adequate storage space. Hardwired smoke and carbon monoxide detectors, and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with handrails and nonskid-floor mats. Hot water was measured at 110 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were in locked cabinets. Fire extinguisher was mounted and charged. For the exterior portion, facility had outside furniture in good repair. Side exit doors were self closing and self latching. LPA discussed the COVID 19 mitigation of the facility; and Assembly Bill (AB) 665. It requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device for use of the residents in care. LPA provided consultation to AD on advantages of using the Guardian. LPA directed AD send all incident reports to CCLASCPOrangeCountyRO@dss.ca.gov

For this visit, no citation was issued on areas observed.

LPA Marin conducted an exit interview with AD Ong and copy of this report was left in the facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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