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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006115
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:27:13 AM

Document Has Been Signed on 03/12/2025 11:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:T3 ADULT CARE RESIDENTIAL CAREFACILITY NUMBER:
306006115
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, GLORIAFACILITY TYPE:
735
ADDRESS:1726 SOUTH LATUS PLACETELEPHONE:
(714) 797-6057
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: 4DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Thien Luu, Administrator (AD)TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 8am. During today’s visit, LPA met with Thien Luu, Administrator (AD).

The facility is a level 4e, four bedroom, single story residence with an approved fire clearance of four ambulatory clients. The facility currently has a census of four clients in care who were all sleeping at time of entry.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, and testing hot water temperature in two of two client bathrooms The hot water temperature measured between 109.4 and 111.3 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on November 5, 2024. The facility’s last fire drill was conducted on December 27,, 2024.

At 10am LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. A food delivery had also arrived during the visit and emergency water and supplies were in the office/garage. LPA observed one client who was cooking breakfast, another was relaxing on the couch and a third client was preparing to go out with family. The fourth client had walked to the gym. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit had the required elements and included an American Red Cross First Aid Book.

AD and LPA toured the exterior of the facility. All video surveillance is only in common areas and outdoors. There were no hazards or obstacles blocking passageways and both exterior gates were unlocked and (Continued on LIC 809-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: T3 ADULT CARE RESIDENTIAL CARE
FACILITY NUMBER: 306006115
VISIT DATE: 03/12/2025
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(Continued from LIC 809)

self-latching. A shaded area was observed in the patio. AD informed LPA the exterior wall near meter is being patched up by contractor.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of client records. One client's P&I record was reviewed and was accurate. Three of the four clients manage their own funds. LPA interviewed alert clients regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on February 13, 2026.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Thien Luu, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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