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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006112
Report Date: 03/24/2022
Date Signed: 03/24/2022 05:01:15 PM


Document Has Been Signed on 03/24/2022 05:01 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:ABK SWEET HOMECARE INC.FACILITY NUMBER:
306006112
ADMINISTRATOR:TRUONG, BRENDAFACILITY TYPE:
740
ADDRESS:10171 NORTHAMPTON AVETELEPHONE:
(714) 837-9198
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:6CENSUS: 5DATE:
03/24/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Brenda TruongTIME COMPLETED:
05:15 PM
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Licensing Program Analysts (LPAs) Claudia Gutierrez and Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPAs met with Administrator (AD) Brenda Truong, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 11/03/2021. This is a change of ownership with persons in care.

During the inspection, LPA and AD observed the following: Structure. This is a two-story home. Facility is a 6-bedroom, 3-bathroom, 2 story house with attached garage that is being used for storage. There is a back yard with a patio cover for the clients. Facility telephone number is (714) 837-9198. Bedrooms Residents. The 4 client bedrooms are spacious and will easily accommodate the client's furnishings. Lamps, chairs, linens, and storage for each client bedroom inspected. Bedrooms staff. The 1 staff bedroom is spacious and will easily accommodate the staff's furnishings. Lamps, chairs, linens, and storage for the staff bedroom inspected. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 107 to 109 F degrees. Linens & Hygiene Supplies. New linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. 7 days nonperishable food supply reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detector/carbon monoxide detector. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen cabinet. Toxins: observed locked under the sink and in a garage closet. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files. LPAs reviewed resident and staff file storage area and multiple resident and staff files. Fire clearance was approved by Orange County Fire Authority Inspector Michael Lombardo on 02/18/2022. Backyard. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Facility is currently operating under the liability insurance of current facility FOUNTAIN VALLEY SWEET HOME (306005463). AD will switch liability insurance to new facility once the application is approved.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ABK SWEET HOMECARE INC.
FACILITY NUMBER: 306006112
VISIT DATE: 03/24/2022
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During the inspection, LPAs and AD noted that the application’s approved fire clearance was for 6 ambulatory residents, but the current facility has 2 non-ambulatory residents. AD stated they would seek a new fire clearance for the maximum non-ambulatory fire clearance. The facility is not currently ready for licensure. AD agreed to work with the Central Applications Bureau and the local Fire Department to secure AD’s desired fire clearance and notify LPAs once the facility is ready for inspection.

During the inspection, LPAs explained the process of this application and about the post licensing inspection once the facility is licensed. AD was informed the items listed above must be completed for the facility to meet Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to AD.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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