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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607431
Report Date: 01/10/2025
Date Signed: 01/10/2025 05:17:16 PM

Document Has Been Signed on 01/10/2025 05:17 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:A + SINCERE CARE MANORFACILITY NUMBER:
197607431
ADMINISTRATOR/
DIRECTOR:
FENGPEI QINFACILITY TYPE:
740
ADDRESS:5029 MCCLINTOCK AVE.TELEPHONE:
(626) 579-7795
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY: 6CENSUS: 11DATE:
01/10/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Hugh He, administratorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Tao made an unannounced case management visit regarding a self-reported incident on the relocation of five (5) residents from Ace Senior Care Manor, Inc from Pasadena (license # 197607681, located at 940 N Lake Avenue, Pasadena, CA 91004) to A+ Sincere Care Manor (license # 197607431) due to the mandatory evacuation orders from Fire Advisory. LPA met with Hugh He, licensee/ administrator of Ace Senior Care Manor from Pasadena and A+ Sincere Care Manor from Temple City and explained the purpose of the visit.

During the visit, LPA Tao conducted a health and safety check and no concerns observed. LPA residents/staff rosters for both facilities were obtained. Per the interview with administrator He, five (5) residents from Ace Senior Care Manor have been relocated to A+ Sincere Care Manor and one (1) resident went home with family. The current location has sufficient beds, hygiene supplies, beddings, linens, and everyone has a designated room. Residents’ rooms and bathrooms are in compliance with the required furnishing. The kitchen has sufficient two-day perishable and seven-day non-perishable food supplies. Medications, MARs, and staff/residents files have been transferred to A+ Sincere Care Manor facility and stored in the locked cabinets.

Hugh Le is the licensee of both facilities. Both facilities use the same vendors, pharmacy, and provide the same level of care to residents. There is sufficient staffing available to provide care for residents at the facility. Hugh He, licensee confirmed all residents’ families/ responsible parties have been notified about the relocation to the current facility, either via calls, texts, or emails.

No issues are observed during the visit. An exit interview was conducted and a copy of this report was provided to Hugh He.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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