306006780-7-2-2026-22-AS-WVAS-DVLP95-20260702110634

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006780
Report Date: 07/02/2026
Date Signed: 07/02/2026 11:06:42 AM

Document Has Been Signed on 07/02/2026 11:06 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:	RISZEN LLC		FACILITY NUMBER:	306006780
ADMINISTRATOR/ DIRECTOR:	KAPOOR, UDIT		FACILITY TYPE:	740
ADDRESS:	630 S BOXWOOD ST		TELEPHONE:	(626) 505-0459
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92802
CAPACITY: 6		CENSUS: 0	DATE:	07/02/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Udit Kapoor (Administrator)		TIME VISIT/ INSPECTION COMPLETED:	11:20 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On today's date Licensing Program Analyst (LPA) William Vanegas and Regional Manager (RM) Monica Tran conducted an announced visit for the purposes of conducting a Prelicensing inspection. Upon arrival LPA and RM were greeted and granted entry to the facility by applicant. LPA explained the purpose for the visit and began to conduct a tour of the facility and observed the following. Structure: The facility is a one storied home equipped with four bedrooms one of which is a staff room and three of which are utilized for residents in care. The facility is equipped with a two car detached garage. The facility is equipped with a large backyard which is sufficient enough to participate in outdoor activities upon resident request. The backyard is equipped with an outdoor shaded area however there is no outdoor furniture for sitting. Applicant has a valid Administrator certificate valid from February 24,2025 through February 23, 2027. The initial application was received on March 28,2025. The initial application requested to be licensed for a capacity of 6 residents 1 of which is bedridden and 5 of which are non-ambulatory. Bedrooms: All resident bedrooms were observed to be large enough to walk about freely, and large enough to accommodate all required furnishings. All bedrooms were observed to have a chest of drawers, a bed, clean linens in good repair; meaning no strains or tears, a chair, a reading lamp, and enough storage space to store personal belongings. LPA observed all bedrooms to be free of any hazards or obstructions. Restrooms: All restrooms were observed to be clean and free of any mildew and debris, all water faucets, and toilets tested operational. LPA observed main restroom to have all required furnishings including a shower chair, grab bars, and slip resistant floor matts. Hot water temperature tested between 116.6 and 116.7 degrees Fahrenheit CONTINUED ON LIC809-C.

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: RISZEN LLC	FACILITY NUMBER: 306006780
	VISIT DATE: 07/02/2026

NARRATIVE

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Linens and Hygiene:
LPA observed a sufficient amount of extra linens and hygiene products in the storage space located in the hallway.

Required Postings:
LPA observed all required postings to be displayed upon entry ways and hallways the following postings include: The rights to resident council, personal rights, PUB 475 (see something say something) sign, Long term care ombudsman sign, first aid posting, visiting policy, and theft and loss policy.

Food Services:
LPA observed kitchen area to be clean and free of any mildew and debris, LPA observed kitchen area to have a refrigerator, gas stove, dishwasher, dryer, and washer all appeared to be in good repair and tested operational. LPA observed for there to be an insufficient amount of emergency water, and an insufficient amount of perishable and non perishable food. LPA observed four dining room chairs to be unstable and not suitable for residents in care to sit and dine comfortably.

Smoke Detectors/Fire Clearance:
LPA observed smoke detectors and carbon monoxide detectors to be in good repair and tested operational. LPA observed fire clearance to be approved and inspected on March 18, 2026 by inspector Brian Riggs. The fire clearance is approved for a capacity of 6 with 1 being bedridden in bedroom number 2. LPA observed first aid kit to have most required items including adhesive tape, bandages, scissors, tweezers, and a thermometer. Applicant is missing a first aid manual issued by the American Red Cross Association or the American Medical Association.

Based on observations made during today's inspection pre licensing is incomplete with deficiencies that will be resolved by July 10, 2026. A follow up pre licensure LIC809 will be generated upon resolution of deficiencies. An exit interview was conducted with applicant and a copy of this report was provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC809 (FAS) - (06/04)

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