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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006112
Report Date: 05/11/2022
Date Signed: 05/11/2022 02:22:44 PM


Document Has Been Signed on 05/11/2022 02:22 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:
05/11/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Administrator Brenda TruongTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Shobhana Frank conducted this announced continued Prelicensing visit today to ensure the facility had made all necessary corrections required from the Prelicensing visit on 3/ 24,2022. LPA Frank met with Administrator (AD) Brenda Truong and Lily Nguyen discussed the purpose of the inspection, and toured the facility.
During the inspection on 3//24/22 LPA Sean Haddad and AD Brenda Truong noted that the application’s approved fire clearance was for 6 ambulatory residents, but the current facility has 2 non-ambulatory residents. AD agreed to work with the Central Applications Bureau and the local Fire Department to secure AD’s desired fire clearance and notify LPA once the facility is ready for inspection.

During the Inspection LPA verified the Fire clearance was granted - room #1 for ambulatory and Room 2,4,5 for Non ambulatory on 4/21/2022.
The item identified for correction during initial Prelicensing visit of March 24, 2022 is now corrected. With the above corrections completed the facility physical plant meets requirements of Title 22 Regulations.
During the inspection LPA Frank conduct component III with the licensure.
All items reviewed during the visit are in compliance. Facility appears to be ready for licensure.
An exit interview was conducted with Administrator and a copy of this report was provided.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Shobhana FrankTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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