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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004758
Report Date: 06/28/2021
Date Signed: 06/28/2021 12:57:32 PM

Document Has Been Signed on 06/28/2021 12:57 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:A&B AT HOME HEALTH HOME CARE FACILITY RCFEFACILITY NUMBER:
306004758
ADMINISTRATOR:JOIEY WSAA J. ONGFACILITY TYPE:
740
ADDRESS:24116 JUANENO DRIVETELEPHONE:
(949) 870-6588
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 5DATE:
06/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:TIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Albert Marin conducted an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Joiey Ong and stated the purpose of this visit.

The facility is licensed for capacity of six non-ambulatory of which 1 may be bedridden; and with hospice waiver for four. For this visit, there was one resident under hospice care.

At 11:50 AM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure of the facility. LPA observed five residents in care and two staff members on the floor. LPA toured the interior and exterior portions of the facility. There were six private resident’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Hardwired smoke, carbon monoxide and auditory exit alarms were observed to be operational. Bathrooms were provided with grab bars, and hot water was at 112 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. Exterior portion of the facility had patio furniture in good repair. Exterior exit doors were self-closing and self-latching.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPA Marin conducted an exit interview with AD J. Ong; and copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2021
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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