<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006429
Report Date: 02/01/2024
Date Signed: 02/01/2024 10:52:14 AM

Document Has Been Signed on 02/01/2024 10:52 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:T&T SWEET HOMECAREFACILITY NUMBER:
306006429
ADMINISTRATOR:MARY HANFACILITY TYPE:
740
ADDRESS:8445 PHILODENDRON WAYTELEPHONE:
(714) 623-3194
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 0DATE:
02/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mary HanTIME COMPLETED:
11:06 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
Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Administrator Mary Han. An application to operate an Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on 9/27/2023.

Structure:
The facility is a one-story house with four bedrooms, two bathrooms, living room, kitchen, dining room, laundry room, and attached two car garage. There is a backyard with an exit gate each side of the house. LPA did not observe any obstacles or hazards in the backyard.

Resident Bedrooms
All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. LPA observed all windows were screened.

Signal system
There is no signal system.

Toxins:
All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink.

Medications, First-Aid Kit & Book:
Medication will be stored in a medication cabinet mounted on the wall in the kitchen area. First aid kit is mounted on the wall in the living room. The first aid kit had all the required elements, but was missing a thermometer.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: T&T SWEET HOMECARE
FACILITY NUMBER: 306006429
VISIT DATE: 02/01/2024
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
26
27
28
29
30
31
32
Resident & Staff Files:
Records will be kept locked in a locked file cabinet.

Pool/Jacuzzi:
No bodies of water were observed.

Fire Extinguisher:
Fire extinguisher is fully charged.

Reading Material, Games, Equipment & Materials:
The facility has books for reading, and other recreational materials for the resident’s use, stored in the living room.

Fire clearance:
Was approved by a fire inspector of Orange County Fire Authority on 12/11/2023. Special conditions noted, “Bedroom #4 is approved for bedridden and non-ambulatory use, rooms #2 & #3 are approved for non-ambulatory, room #1 can only be used for ambulatory use.”

Bedrooms Staff:
There is one staff bedroom.

Bathrooms:
All bathrooms have working plumbing. Hot water measured at 124.4 degrees Fahrenheit.

Linens & Hygiene Supplies:
A supply of extra linen was stored in the hallway storage.

Emergency Phone Numbers, Exit Plan & Menu:
Posted and available, means of exiting, and emergency phone numbers. Food menu is not currently available.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 11 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: T&T SWEET HOMECARE
FACILITY NUMBER: 306006429
VISIT DATE: 02/01/2024
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
26
27
28
29
30
31
32
Food Service:
A supply of 2-day perishable and 7-day of non-perishable food will be maintained on hand.

Smoke Detectors:
Smoke detectors and carbon monoxide detectors tested operational.

Appliances:
Gas five burner stove, refrigerator, microwave, washer, and dryer are operational.

Licensee to address the following corrections by 02/16/2024:

· Water temperatures tested at 124.4 degrees F in residents’ bathroom. Water temperature to be adjusted to meet regulation of 105 to 120 degrees F.

· See Something, Say Something poster (PUB 475) was not observed in the facility. The poster shall be 20” x 26” in size and be posted in the main entryway of the facility.

· Facility does not have a shaded seating or furnished area in any of its outdoors areas. Outdoor areas shall be equipped for outdoor use.

· Hand soap was not available in residents’ bathroom. Hygiene supplies must be provided.

· Fireplace was not observed to be screened. Fireplace to be screened to meet regulation requirement.

· Facility’s policy concerning family visits and other communication with residents was not available for review. Facility shall promptly post notice of its visiting policy at a location in the facility that is accessible to residents and families.

· First aid kit was observed to be missing a thermometer. Thermometer is a required element of first aid kit.

· LPA was unable to conduct an inspection of the garage due to garage being locked and inaccessible. Designated AD was informed all areas of facility must be inspected prior to licensure approval.

LPA will make an additional announced visit to follow-up on corrections listed above. An exit interview was conducted, and a copy of this report was provided to designated AD.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 12 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: T&T SWEET HOMECARE
FACILITY NUMBER: 306006429
VISIT DATE: 02/01/2024
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
26
27
28
29
30
31
32
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 10 of 12