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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006230
Report Date: 11/05/2024
Date Signed: 11/05/2024 10:49:25 AM

Document Has Been Signed on 11/05/2024 10:49 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:TNL RESIDENTIAL CAREFACILITY NUMBER:
306006230
ADMINISTRATOR/
DIRECTOR:		LUU, THIENFACILITY TYPE:
735
ADDRESS:1665 S. IVANHOE ST.TELEPHONE:
(714) 797-6057
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 4CENSUS: 4DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:09 AM
MET WITH:Thien Luu, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:15 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. During today’s visit, LPA met with Thien Luu, Administrator and Max Nguyen, Designated Administrator.

The facility is a four bedroom, two bathroom, level 4c single story building with an attached garage and an approved fire clearance for four ambulatory clients. The facility currently has a census of four clients in care. At the time of LPA's entry at 8:09 AM two of four clients were at Adult Day Program (ADP), one was awaiting transport to attend ADP and one client remained asleep in the living room. A contractor was observed in the backyard clearing yard debris.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperatures in two of two client bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 109.5 and 114.2 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on October 5, 2023. AD will get fire extinguisher re-serviced this week but it is fully charged. The facility’s last fire and earthquake drill was conducted on September 27, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on handLPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid kit had all the required elements with a First Aid Manual.

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of client records. Client P&I records were reviewed and were accurate. LPA interviewed alert client regarding the quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on February 14, 2026.

(Continued on LIC 809-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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: TNL RESIDENTIAL CARE
FACILITY NUMBER: 306006230
VISIT DATE: 11/05/2024
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(Continued from LIC 809)

During the tour LPA observed one of the client bedrooms has two mattresses. AD has physicians' letters on file for this client with our office and Regional Center dated February 15, 2024. A letter has been submitted regarding the Additional Dwelling Unit (ADU) and is permitted with the city.

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 and Max Nguyen, Administrators 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: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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